The Reliability of the Clinical Tests and Questions Recommended in International Guidelines for Low Back Pain.

McCarthy, Christopher James PhD;  Gittins, Matthew MSc;  Roberts, Christopher PhD;  Oldham, Jacqueline Anne PhD

This study undertook a reliability study to evaluate the reliability of the items of the LBP clinical examination with a large sample of LBP patients.  Patients, referred to physiotherapy departments across the United Kingdom with LBP (n = 301) were recruited in a sample of convenience. The 50 questions and physical tests were administered by a physiotherapist and then repeated by another physiotherapist within the same day. Eighty-six percent of the questions and test demonstrated [kappa] of 0.41 (fair agreement) or above. Five questions and 2 physical tests (prone knee bend and myotomal assessment) demonstrated agreement of only slight levels. CIs were generally narrow and the uncertainty regarding the kappa coefficients demonstrated correspondingly low.  The authors conclude that this study has rigorously evaluated the intertester reliability of the clinical examination process of the diagnostic triage. These clinicians generally demonstrated fair agreement when testing features of the "nerve root," "yellow" and "red flag" presentations recommended in international guidelines for the management of LBP and nonspecific LBP. However, reliance on single tests with only fair levels of agreement may be unwise. Further work is required to investigate the validity of the tests.

Spine.    32(8):921-926, April 15, 2007.

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Neck Pain

Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, neck pain ranked 4th highest in terms of disability and 21st in terms of overall burden.

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