Sedaghat Negin, Latimer Jane, Maher Christopher, Wisbey-Roth Trish
Discipline of Physiotherapy, School of Health Sciences, University of Sydney, NSW, Australia.
J Manipulative Physiol Ther. 2007 Sep;30(7):501-8. doi: 10.1016/j.jmpt.2007.07.008.
Over the past decade, instrument and palpation methods for quantifying the activation and recruitment of the transversus abdominis and lumbar multifidus have been proposed. Palpation methods however have recently been described and therefore have been subjected to little evaluation. One such palpation method is the Wisbey-Roth grading system. The recruitment of the transversus abdominis and lumbar multifidus is assessed in a series of functional body positions and movements. The ability to recruit these muscles is quantified by assigning 1 of 6 defined grades. The purpose of this study was to investigate the reproducibility of this grading system.
A total of 2 meetings and 3 pilot trials were held with raters before commencement of the study to establish an agreed grading system protocol. Interrater reproducibility was investigated using a Latin square repeated measures design. Thirty-four subjects (62% male and 38% female; age range, 15-70 years) with a history of low back pain participated. A total of 4 practicing physiotherapists and 1 sports medicine physician graded subjects using the Wisbey-Roth grading system protocol.
Pair-wise weighted kappa values ranged from -0.01 (95% confidence interval [CI], -0.33 to 0.31) to 0.56 (95% CI, 0.25 to 0.87), with average weighted kappa being 0.29. The intraclass correlation coefficient (2,1) was 0.30 (95% CI, 0.15 to 0.48), and the standard error of the measurement was 1.6 units.
The Wisbey-Roth grading system shows fair to poor reproducibility between raters. Therefore, it should not be used to exchange meaningful information between clinicians. Recommendations are made for further research and toward improving its reproducibility.
在过去十年中，已经提出了用于量化腹横肌和腰多裂肌激活和募集的仪器和触诊方法。然而，触诊方法最近才被描述，因此很少受到评估。其中一种触诊方法是威斯贝-罗斯分级系统。在一系列功能性身体姿势和动作中评估腹横肌和腰多裂肌的募集情况。通过指定6个定义等级中的1个来量化募集这些肌肉的能力。本研究的目的是调查该分级系统的可重复性。
在研究开始前，与评估者共举行了2次会议和3次预试验，以建立商定的分级系统方案。使用拉丁方重复测量设计研究评估者间的可重复性。34名有腰痛病史的受试者（62%为男性，38%为女性；年龄范围15 - 70岁）参与研究。共有4名执业物理治疗师和1名运动医学医生使用威斯贝-罗斯分级系统方案对受试者进行分级。
两两加权kappa值范围为-0.01（95%置信区间[CI]，-0.33至0.31）至0.56（95%CI，0.25至0.87），平均加权kappa为0.29。组内相关系数（2,1）为0.30（95%CI，0.15至0.48），测量标准误差为1.6个单位。
威斯贝-罗斯分级系统在评估者之间的可重复性显示为中等至较差。因此，它不应被用于临床医生之间交换有意义的信息。针对进一步研究和提高其可重复性提出了建议。
