Intertester reliability of a low back pain classification system.

STUDY DESIGN

This prospective study of intertester reliability examined pairs of therapists' ability to agree independently on a patient's low back pain diagnosis.

OBJECTIVE

To determine the intertester reliability of a low back pain classification system among experienced and novice clinicians.

BACKGROUND

Many of the disparate categorization schemes for patients with low back pain are purely nominal, assigning designations based on the presumptive source of the problem without providing any practical guide for rehabilitation. A useful classification scheme reliably groups patients into treatment-directing categories.

METHODS

The study included 204 patients with low back pain referred to 10 clinics across Canada. Paired physiotherapists performed separate physical examinations on each patient. Both examiners then completed a simple ballot choosing one of five pain patterns.

RESULTS

Agreement on patient classification by independent examiners was 78.9% (kappa = 0.61).

CONCLUSION

This clinically relevant and clearly defined pain pattern system uses key elements of the history and examination to classify patients with low back pain. The pattern provides a framework for initiating active rehabilitation strategy. Using this approach, clinicians agreed on the categorization of 78.9% of mechanical low back pain cases.