White L J, Thomas J S
Department of Physical Therapy, University of Illinois, Chicago, IL, USA.
J Back Musculoskelet Rehabil. 2002 Jan 1;16(2):83-90. doi: 10.3233/bmr-2002-162-306.
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.
本研究的主要目的是检验物理治疗师使用由Sahrmann开发的运动系统平衡（MSB）方法中的运动测试方案对腰痛进行分类评估时的评分者间信度。第二个目的是确定参加继续教育课程是否能提高信度。选取了37例腰痛患者（平均年龄 = 37.2，标准差 = 13.6，范围 = 20 - 63岁）作为便利样本参与研究。每位患者由一对检查者进行检查。其中一对检查者都参加了为期三天的继续教育课程，另一对则未参加。在每对检查者中，使用16项运动测试对同一受试者进行单独检查。检查者需判定测试是否引发症状以及是哪种运动（屈曲、伸展或旋转）导致的。计算了卡帕系数以及在阳性和阴性判定中的一致比例。配对t检验表明，基于检查者培训类型，每对检查者在每项运动测试中的一致性没有差异，因此在其余分析中将结果合并。运动测试的卡帕统计量范围为（0.02 - 0.62），表明16项测试中有6项显示出令人满意的信度。结果表明，参加继续教育课程或从印刷材料或视频中学习这些技术的临床医生应谨慎应用基于这些运动测试的临床决策。
