Hidalgo Benjamin, Hall Toby, Nielens Henri, Detrembleur Christine
Assistant Professor, Institute of Neuroscience, Faculty of Motor Sciences, University of Louvain, Brussels, Belgium.
Senior Teaching Fellow, The University of Western Australia, Perth, Australia; Adjunct Senior Teaching Fellow, School of Physiotherapy, Curtin Innovation Health Research Institute, Curtin University of Technology, Perth, Australia.
J Manipulative Physiol Ther. 2014 Feb;37(2):105-15. doi: 10.1016/j.jmpt.2013.09.006. Epub 2014 Jan 6.
The purpose of this study was to evaluate the interexaminer agreement and validity of active and passive pain provocation tests in the lumbar spine.
Two blinded raters examined 36 participants, 18 of whom were asymptomatic and 18 reported subacute nonspecific low back pain (LBP). Two types of pain provocation tests were performed: (1) physiological movements in single (flexion/extension) and, when necessary, combined planes and (2) passive accessory intervertebral movement tests of each lumbar vertebra in prone with the lumbar spine in neutral, flexion, and extension position.
The interobserver agreement in both groups was good to excellent for the identification of flexion (κ = 0.87-1) or extension (κ = 0.65-0.74) as the most painful pattern of spinal movement. In healthy participants, 0% was identified as having a flexion provocative pattern and 8.8% were identified as having an extension provocative pattern. In the LBP group, 20% were identified as having a flexion provocative pattern vs 60% with an extension provocative pattern. The average interexaminer agreement for passive accessory intervertebral movement tests in both groups was moderate to excellent (κ = 0.42-0.83). The examiners showed good sensitivity (0.67-0.87) and specificity (0.82-0.85) to distinguish participants with LBP using this combined examination procedure.
The use of a combination of pain provocative tests was found to have acceptable interexaminer reliability and good validity in identifying the main pain provocative movement pattern and the lumbar segmental level of involvement. These pain provocation tests were able to distinguish participants with LBP from asymptomatic participants and may help clinicians in directing manual therapy treatment.
本研究旨在评估腰椎主动和被动疼痛激发试验的检查者间一致性及有效性。
两名盲法评估者对36名参与者进行检查，其中18名无症状，18名报告有亚急性非特异性下腰痛（LBP）。进行了两种类型的疼痛激发试验：（1）单个平面（屈曲/伸展）以及必要时联合平面的生理运动；（2）在俯卧位下，腰椎处于中立、屈曲和伸展位时，对每个腰椎椎体进行被动椎间辅助运动试验。
两组中，对于确定屈曲（κ = 0.87 - 1）或伸展（κ = 0.65 - 0.74）为最疼痛的脊柱运动模式，观察者间一致性良好至优秀。在健康参与者中，0%被确定有屈曲激发模式，8.8%被确定有伸展激发模式。在LBP组中，20%被确定有屈曲激发模式，而60%有伸展激发模式。两组被动椎间辅助运动试验的平均检查者间一致性为中等至优秀（κ = 0.42 - 0.83）。使用这种联合检查程序，评估者在区分LBP参与者方面表现出良好的敏感性（0.67 - 0.87）和特异性（0.82 - 0.85）。
发现使用疼痛激发试验组合在确定主要疼痛激发运动模式和腰椎受累节段水平方面具有可接受的检查者间可靠性和良好的有效性。这些疼痛激发试验能够区分LBP参与者和无症状参与者，并可能有助于临床医生指导手法治疗。
