Interrater reliability of clinical examination measures for identification of lumbar segmental instability

Abstract

Hicks GE, Fritz JM, Delitto A, Mishock J. Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil 2003;84:1858–64. Objective To determine the interrater reliability of common clinical examination procedures proposed to identify patients with lumbar segmental instability. Design Single group repeated-measures interrater reliability study. Setting Outpatient physical therapy (PT) clinic and university PT department. Participants A consecutive sample of 63 subjects (38 women, 25 men; 81% with previous episodes of low back pain [LBP]) with current LBP was examined by 3 pairs of raters. Interventions Not applicable. Main outcome measures Repeat measurements of clinical signs and tests proposed to identify lumbar segmental instability. Results Kappa values for the trunk range of motion (ROM) findings varied (range, .00–.69). The prone instability test (κ=.87) showed greater reliability than the posterior shear test (κ=.22). The Beighton Ligamentous Laxity Scale (LLS) for generalized ligamentous laxity showed high reliability (intraclass correlation coefficient=.79). Judgments of pain provocation (κ range, .25–.55) were generally more reliable than judgments of segmental mobility (κ range, −.02 to .26) during passive intervertebral motion testing. Conclusions The results agree with previous studies suggesting that segmental mobility testing is not reliable. The prone instability test, generalized LLS, and aberrant motion with trunk ROM demonstrated higher levels of reliability.