The rater reliability of assessments of symptom provocation in patients with low back pain.

The primary purpose of this study was to test the inter-rater reliability of assessments by physical therapists using the movement testing protocol from the Movement System Balance (MSB) approach developed by Sahrmann for classification of low back pain. A second purpose was to determine if attendance at a continuing education course improves reliability. A convenience sample of 37 patients with low back pain (mean age = 37.2 SD = 13.6, range = 20 - 63) participated. Each patient was examined by a pair of examiners. One examiner pair had both attended a three day continuing education course and one pair had not. Within each pair of examiners, separate examinations of the same subject were done using 16 movement tests. The examiners made a decision whether the test provoked symptoms and which movement (flexion, extension, or rotation) was the cause. Kappa coefficients and proportionate agreement in positive and negative decisions were calculated. A paired t-test showed no difference between the agreement of the examiner pairs for each movement test based on type of examiner training so the results were combined for the rest of the analysis. The range of kappas statistics for the movement tests (0.02-0.62) indicated 6 of the 16 tests showed satisfactory reliability. The results suggest that that clinicians attending continuing education courses or learning these techniques from printed materials or videos should apply clinical decisions based on these movement tests judiciously.