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

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 (kappa=.87) showed greater reliability than the posterior shear test (kappa=.22). The Beighton Ligamentous Laxity Scale (LLS) for generalized ligamentous laxity showed high reliability (intraclass correlation coefficient=.79). Judgments of pain provocation (kappa range,.25-.55) were generally more reliable than judgments of segmental mobility (kappa 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.