Interrater Agreement on Assessment, Diagnosis, and Treatment for Neck Pain by Trained Physical Therapist Students

Abstract

Background and Purpose. Clinicians trained in Mechanical Diagnosis and Therapy (MDT) for neck pain (NP) have been shown to reliably link diagnosis to treatment. No studies have been done with physical therapist students. Study objectives were to determine interrater agreement on MDT diagnosis, MDT initial treatment, and the diagnosis-treatment link of students trained in MDT for NP. Additionally, diagnosis-treatment results were compared with those of 50 experienced clinicians trained in MDT for NP. Subjects. Participants were 17 Master of Physical Therapy (MPT) students who were MDT trained for NP. Methods. Students viewed videorecorded MDT assessments of 20 patients with NP and selected respective MDT diagnosis and initial treatment categories. Interrater agreement on MDT diagnosis, initial treatment, and diagnosis-treatment link was determined with kappa (κ), and percent agreement (%). Chi-square (χ^sup 2^) was used to compare interrater agreement on the diagnosis-treatment link and results from a previous study using experienced clinicians trained in MDT for NP. Results. The student interrater agreement was 85.59% for MDT diagnosis, 87.94% for initial treatment and 90.88% for diagnosis-treatment link. Rater consistency was moderately high with κ = .50 for diagnosis, .55 for initial treatment and .58 for diagnosis-treatment. Clinicians had 86.67% agreement on the MDT diagnosis-initial treatment link with moderate consistency (κ = .46; CI = .45-.47). The consistency of the students was significantly higher than the clinicians (χ^sup 2^ = 88.67; P Discussion and Conclusion. Students and clinicians trained in MDT for NP demonstrated moderate reliability when linking the MDT diagnosis to initial treatment. The difference in consistency between students and experienced clinicians was clinically small (difference in kappa of 0.12), but statistically significant, with students demonstrating more consistency. Key Words: Reliability, Mechanical Diagnosis and Therapy, Students. BACKGROUND AND PURPOSE One objective of physical therapist education in the United States is to produce graduates ready for independent practice in a doctoring profession.1 To address that objective in the limited area of spine care, the faculty at the University of Texas at El Paso (UTEP) Physical Therapy Program decided that, rather than supply an overview of the many existing approaches, they would provide students with a relatively complete tool to address spine care. The faculty adopted the Mechanical Diagnosis and Therapy (MDT) approach advocated by Robin McKenzie.2,3 The UTEP curriculum covers the basics of MDT lumbar, thoracic, and cervical spine management.4 The MDT approach was selected based on its widespread use and popularity throughout the world, supported by surveys conducted in the United States,5 England, and Ireland.6 More important, there is mounting evidence to support MDT as a reliable, valid system for management of patients with low back pain (LBP)7-11 and neck pain (NP).11-13 The study had 4 objectives: 1) to determine whether PT students trained in MDT can reliably arrive at a diagnosis (evaluation) for NP; 2) to determine if PT students trained in MDT can reliably arrive at an initial treatment (intervention) for patients with NP; 3) to determine whether PT students trained in MDT can reliably select the MDT diagnosis that corresponds to a given initial treatment for NP; and 4) to compare performance of entry-level PT students to more highly trained and experienced clinicians on the correspondence of MDT diagnosis to initial treatment for NP. The common medical terminology for the process of assessment, diagnosis, and treatment will be used in this manuscript to speak to the larger audience. It is understood that equivalent US physical therapy language for the process would be examination, evaluation and intervention respectively. Review of the Literature Studies support the reliability of diagnostic MDT components for LBP7-11,14-19 and NP. …