Bertilson Bo C, Bring Johan, Sjöblom Anneli, Sundell Karin, Strender Lars-Erik
Karolinska Institutet, Center for Family Medicine, Alfred Nobels ellé 12, Huddinge, Stockholm, 141 83, Sweden.
Eur Spine J. 2006 Nov;15(11):1695-703. doi: 10.1007/s00586-005-0050-3. Epub 2006 Jan 25.
Reliable classification systems and clinical tests are sought for the care of patients with low back pain (LBP). The objectives of this clinical study were to evaluate inter-examiner reliability in the classification of patients with LBP, the influence of radiological findings on the classification and the reliability of some clinical tests. Two examiners independently assessed 50 outpatients with LBP. Inter-examiner reliability in classification of patients with LBP using Kirkkaldy-Willis classification (KWC) system and in 30 clinical tests was calculated as percentage agreement and kappa coefficients (kappa). Inter-examiner reliability was excellent (kappa>0.8) for classification according to KWC. Radiological findings did not influence the reliability. Age of the patient, movement range, and pain and neurological signs seemed to guide the decision on classification. The reliability of clinical tests was good (kappa>0.6) in 6 tests and moderate (kappa>0.4) in 12 tests. Good inter-examiner reliability was found for the SLR test, movement range and sensibility testing with spurs in dermatome areas. We conclude that the KWC for classifying patients with LBP seems to be a reliable classification system depending on a few key observations and that moderate and good inter-examiner reliability can be achieved in several clinical tests in the assessment of LBP.
人们一直在寻找可靠的分类系统和临床测试方法来治疗腰痛（LBP）患者。本临床研究的目的是评估检查者间在腰痛患者分类中的可靠性、影像学检查结果对分类的影响以及一些临床测试的可靠性。两名检查者独立评估了50例腰痛门诊患者。使用柯卡尔迪 - 威利斯分类（KWC）系统对腰痛患者进行分类以及30项临床测试中的检查者间可靠性，通过一致性百分比和kappa系数（kappa）来计算。根据KWC分类的检查者间可靠性极佳（kappa>0.8）。影像学检查结果不影响可靠性。患者年龄、活动范围、疼痛和神经体征似乎指导了分类决策。6项临床测试的可靠性良好（kappa>0.6），12项临床测试的可靠性中等（kappa>0.4）。直腿抬高试验、活动范围以及皮节区域带刺激的感觉测试的检查者间可靠性良好。我们得出结论，用于腰痛患者分类的KWC似乎是一个可靠的分类系统，它依赖于一些关键观察结果，并且在评估腰痛的多项临床测试中可以实现中等和良好的检查者间可靠性。
