Hicks Gregory E, Fritz Julie M, Delitto Anthony, Mishock John
Clinical Research Branch, National Institute on Aging, Harbor Hospital, 5th Floor, 3001 S. Hanover Street, Baltimore, MD 21225, USA.
Arch Phys Med Rehabil. 2003 Dec;84(12):1858-64. doi: 10.1016/s0003-9993(03)00365-4.
To determine the interrater reliability of common clinical examination procedures proposed to identify patients with lumbar segmental instability.
Single group repeated-measures interrater reliability study.
Outpatient physical therapy (PT) clinic and university PT department.
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.
Not applicable.
Repeat measurements of clinical signs and tests proposed to identify lumbar segmental instability.
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.
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.
确定用于识别腰椎节段性不稳定患者的常见临床检查程序的评分者间信度。
单组重复测量评分者间信度研究。
门诊物理治疗（PT）诊所和大学PT系。
63名受试者（38名女性，25名男性；81%曾有过腰痛[LBP]发作史）的连续样本，当前患有LBP，由3对评分者进行检查。
不适用。
对用于识别腰椎节段性不稳定的临床体征和检查进行重复测量。
躯干活动范围（ROM）结果的kappa值各不相同（范围为0.00 - 0.69）。俯卧位不稳定试验（kappa = 0.87）显示出比后剪切试验（kappa = 0.22）更高的信度。用于评估全身韧带松弛的Beighton韧带松弛量表（LLS）显示出高信度（组内相关系数 = 0.79）。在被动椎间运动测试期间，疼痛激发的判断（kappa范围为0.25 - 0.55）通常比节段性活动度的判断（kappa范围为 - 0.02至0.26）更可靠。
结果与先前的研究一致，表明节段性活动度测试不可靠。俯卧位不稳定试验、全身LLS以及躯干ROM异常运动显示出更高水平的信度。
