青少年脊柱筛查：常用临床检查的组内和组间可靠性和测量误差。
Screening of the spine in adolescents: inter- and intra-rater reliability and measurement error of commonly used clinical tests.
机构信息
Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.
出版信息
BMC Musculoskelet Disord. 2014 Feb 10;15:37. doi: 10.1186/1471-2474-15-37.
BACKGROUND
Evidence on the reliability of clinical tests used for the spinal screening of children and adolescents is currently lacking. The aim of this study was to determine the inter- and intra-rater reliability and measurement error of clinical tests commonly used when screening young spines.
METHODS
Two experienced chiropractors independently assessed 111 adolescents aged 12-14 years who were recruited from a primary school in Denmark. A standardised examination protocol was used to test inter-rater reliability including tests for scoliosis, hypermobility, general mobility, inter-segmental mobility and end range pain in the spine. Seventy-five of the 111 subjects were re-examined after one to four hours to test intra-rater reliability. Percentage agreement and Cohen's Kappa were calculated for binary variables, and interclass correlation (ICC) and Bland-Altman plots with Limits of Agreement (LoA) were calculated for continuous measures.
RESULTS
Inter-rater percentage agreement for binary data ranged from 59.5% to 100%. Kappa ranged from 0.06-1.00. Kappa ≥ 0.40 was seen for elbow, thumb, fifth finger and trunk/hip flexion hypermobility, pain response in inter-segmental mobility and end range pain in lumbar flexion and extension. For continuous data, ICCs ranged from 0.40-0.95. Only forward flexion as measured by finger-to-floor distance reached an acceptable ICC(≥ 0.75). Overall, results for intra-rater reliability were better than for inter-rater reliability but for both components, the LoA were quite wide compared with the range of assessments.
CONCLUSION
Some clinical tests showed good, and some tests poor, reliability when applied in a spinal screening of adolescents. The results could probably be improved by additional training and further test standardization. This is the first step in evaluating the value of these tests for the spinal screening of adolescents. Future research should determine the association between these tests and current and/or future neck and back pain.
背景
目前缺乏用于儿童和青少年脊柱筛查的临床检测可靠性的证据。本研究旨在确定用于青少年脊柱筛查的常用临床检测的组内和组间可靠性和测量误差。
方法
两位经验丰富的脊医分别评估了从丹麦一所小学招募的 111 名 12-14 岁的青少年。使用标准化的检查方案来测试组间可靠性，包括脊柱侧弯、过度活动、整体活动、节段间活动和脊柱末端疼痛的测试。其中 111 名受试者中的 75 名在 1 至 4 小时后重新检查，以测试组内可靠性。对于二项变量，计算了百分比一致性和 Cohen's Kappa；对于连续测量，计算了组内相关系数（ICC）和 Bland-Altman 图与界限协议（LoA）。
结果
对于二项数据，组间百分比一致性范围为 59.5%至 100%。Kappa 范围为 0.06-1.00。肘、拇指、第五指和躯干/臀部弯曲过度活动、节段间活动中的疼痛反应以及腰椎前屈和伸展的末端范围疼痛的 Kappa 值为 0.40 或更高。对于连续数据，ICC 范围为 0.40-0.95。只有手指到地板的距离的前屈达到了可接受的 ICC（≥0.75）。总体而言，组内可靠性的结果优于组间可靠性，但对于两者，与评估范围相比，LoA 都相当宽。
结论
在对青少年进行脊柱筛查时，一些临床检测显示出良好的可靠性，而一些检测则显示出较差的可靠性。通过额外的培训和进一步的测试标准化，这些结果可能会得到改善。这是评估这些测试用于青少年脊柱筛查的价值的第一步。未来的研究应确定这些测试与当前和/或未来的颈部和背部疼痛之间的关系。
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