Abstract
BackgroundIn the rehabilitation of patients with prolonged back and neck pain, the physical impairment should be assessed. Previous research has exclusively engaged medically educated examiners, mostly physiotherapists. However, less biased evaluations of efforts at rehabilitation might be achieved by personnel standing outside the treatment work itself. Therefore, if medically untrained examiners could be used without cost to the quality, this might produce a better evaluation at defensible cost and could also be useful in a research context. The aim of this study was to answer the question: given a 10-test package for patients with prolonged back and neck pain, could an examiner without formal medical education be used without loss of quality? Five of the ten tests required the examiner to keep a firm hold against the foundation of those parts of the participant's body that were not supposed to move during the test.MethodsExamination by an experienced physiotherapist (A) in performing the package was compared with that by a research assistant (B) without formal medical education. The reliability, including inter- and intra-rater reliability, was assessed. In the inter-rater reliability study, 50 participants (30 patients + 20 healthy subjects) were tested once each by A and B. In the intra-rater reliability study, the 20 healthy subjects were tested twice by A or B. One-way ANOVA intra-class-correlation coefficient (ICC) was calculated and its possible systematic error was determined using a t-test.ResultsAll five tests that required no manual fixation had acceptable reliability (ICC > .60 and no indication of systematic error). Only one of the five tests that required fixation had acceptable reliability. The difference (five vs. one) was significant (p = .01).ConclusionIn a 10-test package for patients with prolonged back and neck pain, an examiner without formal medical education could be used without loss of quality, at least for the five tests requiring no manual fixation. To make our results more generalizable and their implications more searching, a similar study should be conducted with two or more examiners with and without formal medical education, and the intra-rater reliability study should also include patients and involve more participants.
Highlights
In the rehabilitation of patients with prolonged back and neck pain, the physical impairment should be assessed
The aim of this study was to answer the question: given a 10-test package for patients with prolonged back and neck pain, could an examiner without formal medical education be used without loss of quality?
We chose to consider an intra-classcorrelation coefficient (ICC) > .60 to indicate acceptable reliability and an ICC ≤ .60 to indicate poor reliability, which is a modification of Landis and Koch [30] and in line with the recommendation of Chinn [31]
Summary
In the rehabilitation of patients with prolonged back and neck pain, the physical impairment should be assessed. If medically untrained examiners could be used without cost to the quality, this might produce a better evaluation at defensible cost and could be useful in a research context. The aim of this study was to answer the question: given a 10-test package for patients with prolonged back and neck pain, could an examiner without formal medical education be used without loss of quality? In the rehabilitation of patients with prolonged back and neck pain, it is necessary to assess the physical impairment, i.e. the pathological, anatomical or physiological abnormality of structure or function leading to loss of normal ability [2]. If in a lifting test the patient is able to lift 10 kg as maximum, how is the clinical meaning for that individual interpreted? the concept of validity is outside the framework of this study
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