Qvistgaard Etienne, Rasmussen Jens, Laetgaard Jes, Hecksher-Sørensen Steen, Bliddal Henning
The Parker Institute, H:S Frederiksberg Hospital, 2000, Frederiksberg, Denmark.
Eur Spine J. 2007 Feb;16(2):277-82. doi: 10.1007/s00586-006-0134-8. Epub 2006 May 6.
Examination is a cornerstone in the manual procedures leading to mobilisation/manipulation of the low back. The observer variation of the more specific segmental tests remains to be investigated. Two skilled specialists in manual medicine examined the segmental changes in the lumbar spine. The patients were unknown to the examiners and no information of the case history was given. All test results were recorded by an observer present in the room who ensured that no conversation was allowed during the examination. The primary outcome measures were the kappa values for each test. The matching was defined as acceptable (acc) within two neighbouring levels and perfect (per) on the same level. Intra-observer variation (tested in 33 patients and 10 subjects without low-back pain): The agreement between first and second segmental diagnosis examination was 70% (per) and 82% (per + acc). Kappa values were: segmental diagnosis 0.60 (per) and 0.70 (per + acc), multifidus test 0.51 (per) and 0.60 (per + acc), sideflexion 0.57 (per) and 0.69 (per + acc), and ventral flexion 0.31 (per) and 0.45 (per + acc). Inter-observer variation (tested in 60 patients): The agreement for segmental diagnosis between the examiner A and B was 42% (per) and 75% (per + acc). Kappa values were: segmental diagnosis 0.21 (per) and 0.57 (acc), multifidus test 0.12 (per) and 0.48 (acc), sideflexion 0.22 (per) and 0.45 (acc), and ventralflexion 0.22 (per) and 0.44 (acc). By manual tests, skilled examiners seem to be able to diagnose segmental dysfunctions in the low back. The clinical implication of these dysfunctions remains to be clarified.
检查是导致下背部松动/整复的手法操作的基石。更具体的节段性检查的观察者间差异仍有待研究。两名熟练的手法医学专家检查了腰椎的节段性变化。检查者对患者不了解，且未提供病史信息。所有测试结果由在场的一名观察者记录，该观察者确保检查期间不允许交谈。主要结局指标是每项测试的kappa值。匹配度在相邻两个节段水平内定义为可接受（acc），在同一节段水平定义为完美（per）。观察者内差异（在33例患者和10名无下背痛的受试者中进行测试）：首次和第二次节段性诊断检查之间的一致性为70%（per）和82%（per + acc）。kappa值分别为：节段性诊断0.60（per）和0.70（per + acc），多裂肌测试0.51（per）和0.60（per + acc），侧屈0.57（per）和0.69（per + acc），以及前屈0.31（per）和0.45（per + acc）。观察者间差异（在60例患者中进行测试）：检查者A和B之间节段性诊断的一致性为42%（per）和75%（per + acc）。kappa值分别为：节段性诊断0.21（per）和0.57（acc），多裂肌测试0.12（per）和0.48（acc），侧屈0.22（per）和0.45（acc），以及前屈0.22（per）和0.44（acc）。通过手法测试，熟练的检查者似乎能够诊断下背部的节段性功能障碍。这些功能障碍的临床意义仍有待阐明。
