麦肯锡腰椎分类：不同程度接受过正式麦肯锡研究生培训的物理治疗师之间的评分者间信度。
McKenzie lumbar classification: inter-rater agreement by physical therapists with different levels of formal McKenzie postgraduate training.
机构信息
*CentraState Medical Center, Freehold, NJ †Physical Therapy Service, Maccabi Healthcare Services, Tel Aviv, Israel ‡Focus On Therapeutic Outcomes, Inc., White Stone, VA §School of Rehabilitation Science, Institute of Applied Sciences and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada ¶Physical Therapy Service, Maccabi Healthcare Services, Tel Aviv, Israel ‖Team Care Physical Therapy, Oxford, NC **Physical Therapy Department, St David's Hospital Austin, TX; and ††Providence VA Medical Center, Providence, RI, and Department of Health Services, Policy and Practice, Brown University, Providence, RI.
出版信息
Spine (Phila Pa 1976). 2014 Feb 1;39(3):E182-90. doi: 10.1097/BRS.0000000000000117.
STUDY DESIGN
Inter-rater chance-corrected agreement study.
OBJECTIVE
The aim was to examine the association between therapists' level of formal precredential McKenzie postgraduate training and agreement on the following McKenzie classification variables for patients with low back pain: main McKenzie syndromes, presence of lateral shift, derangement reducibility, directional preference, and centralization.
SUMMARY OF BACKGROUND DATA
Minimal level of McKenzie postgraduate training needed to achieve acceptable agreement of McKenzie classification system is unknown.
METHODS
Raters (N = 47) completed multiple sets of 2 independent successive examinations at 3 different stages of McKenzie postgraduate training (levels parts A and B, part C, and part D). Agreement was assessed with κ coefficients and associated 95% confidence intervals. A minimum κ threshold of 0.60 was used as a predetermined criterion for level of agreement acceptable for clinical use.
RESULTS
Raters examined 1662 patients (mean age = 51 ± 15; range, 18-91; females, 57%). Data distributions were not even and were highly skewed for all classification variables. No training level studied had acceptable agreement for any McKenzie classification variable. Agreements for all levels of McKenzie postgraduate training were higher than expected by chance for most of the classification variables except parts A and B training level for judging lateral shift and centralization and part D training level for judging reducibility. Agreement between training levels parts A and B, part C, and part D were similar with overlapping 95% confidence intervals.
CONCLUSION
Results indicate that level of inter-rater chance-corrected agreement of McKenzie classification system was not acceptable for therapists at any level of formal McKenzie postgraduate training. This finding raises concerns about the clinical utility of the McKenzie classification system at these training levels. Additional studies are needed to assess agreement levels for therapists who receive additional training or experience at the McKenzie credentialed or diploma levels.
LEVEL OF EVIDENCE
研究设计
观察者间机遇校正一致性研究。
目的
旨在探讨治疗师接受的 McKenzie 认证研究生培训水平与以下腰痛 McKenzie 分类变量的一致性：主要 McKenzie 综合征、侧移存在、紊乱可复位性、方向偏好和集中化。
背景资料概要
目前尚不清楚 McKenzie 研究生培训的最低水平可以达到 McKenzie 分类系统的可接受一致性。
方法
观察者（N=47）在 McKenzie 研究生培训的 3 个不同阶段（A 部分和 B 部分、C 部分和 D 部分）完成了多组 2 次独立连续检查。一致性采用κ系数和相关 95%置信区间进行评估。0.60 的最小κ阈值用作临床使用可接受一致性水平的预定标准。
结果
观察者检查了 1662 名患者（平均年龄=51±15；范围，18-91；女性，57%）。所有分类变量的数据分布不均，且高度偏态。未研究的培训水平对任何 McKenzie 分类变量均无可接受的一致性。对于大多数分类变量，除 A 部分和 B 部分培训水平用于判断侧移和集中化以及 D 部分培训水平用于判断可复位性外，所有 McKenzie 研究生培训水平的一致性均高于预期的机遇水平。A 部分和 B 部分、C 部分和 D 部分之间的培训水平之间的一致性相似，置信区间重叠。
结论
结果表明，在任何形式的 McKenzie 研究生培训水平下，治疗师 McKenzie 分类系统的机遇校正观察者间一致性水平均不可接受。这一发现引起了对这些培训水平下 McKenzie 分类系统临床实用性的关注。需要进一步研究以评估在 McKenzie 认证或文凭级别接受额外培训或经验的治疗师的一致性水平。
证据水平
2 级。
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