May Stephen, Littlewood Chris, Bishop Annette
Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom.
Aust J Physiother. 2006;52(2):91-102. doi: 10.1016/s0004-9514(06)70044-7.
The purpose of this systematic review was to determine the quality of the research and to assess the reliability of different types of physical examination procedures used in the assessment of patients with non-specific low back pain. A search of electronic databases (MEDLINE, PEDro, AMED, EMBASE, Cochrane, and CINAHL) up to August 2005 identified 48 relevant studies which were analysed for quality and reliability. Pre-established criteria were used to judge the quality of the studies and satisfactory reliability, and conclusions emphasised high quality studies (> or = 60% methods score). The mean quality score of the studies was 52% (range 0 to 88%), indicating weak to moderate methodology. Based on the upper threshold used (kappa/ICC > 0.85) most procedures demonstrated either conflicting evidence or moderate to strong evidence of low reliability. When the lower threshold was used (kappa/ICC > 0.70) evidence about pain response to repeated movements changed from contradictory to moderate evidence for high reliability. Most procedures commonly used by clinicians in the examination of patients with back pain demonstrate low reliability.
本系统评价的目的是确定研究质量，并评估用于非特异性腰痛患者评估的不同类型体格检查程序的可靠性。检索截至2005年8月的电子数据库（MEDLINE、PEDro、AMED、EMBASE、Cochrane和CINAHL），共识别出48项相关研究，并对其质量和可靠性进行了分析。采用预先设定的标准来判断研究质量和可靠性是否令人满意，结论强调高质量研究（方法评分≥60%）。研究的平均质量评分为52%（范围为0至88%），表明方法学质量较弱至中等。基于所使用的上限阈值（kappa/ICC>0.85），大多数程序显示出相互矛盾的证据或低可靠性的中度至强证据。当使用下限阈值（kappa/ICC>0.70）时，关于重复运动疼痛反应的证据从矛盾变为高度可靠性的中度证据。临床医生在检查背痛患者时常用的大多数程序显示出低可靠性。
