Department of Rehabilitation Services, Shriners Hospitals for Children-Canada, Montreal, Canada.
Department of Physical Therapy, Active Solution Physiotherapy, Montreal, Canada.
J Man Manip Ther. 2021 Aug;29(4):255-261. doi: 10.1080/10669817.2021.1874189. Epub 2021 Jan 24.
To investigate the inter-rater reliability of Mechanical Diagnosis and Therapy (MDT)-trained Diplomats in classifying adolescents and young adults with lumbar pain.
Forty-three participants (mean age 15 ± 2 years) with lumbar pain, with or without lower extremity symptoms, were assessed simultaneously by three MDT Diploma holders and classified into one of three groups: 1) Derangement, 2) Dysfunction, 3) Postural/OTHER. Inter-rater reliability was calculated using the Fleiss kappa statistics with 95% confidence intervals (CI). Analyses were repeated with the younger (11 to 15 years old) and older (16 to 21 years old) age groups.
There was moderate reliability (Fleiss kappa = 0.50, 95% CI = 0.45 to 0.54) for the entire sample, which was statistically significant (p < 0.001). There was good reliability in older participants (Fleiss kappa = 0.63, 95% CI = 0.57 to 0.70), but poor reliability in younger participants (Fleiss kappa = 0.33, 95% CI = 0.27 to 0.39). There was 100% agreement in classifications among assessors for 70% of participants.
The MDT system has moderate reliability when classifying lumbar pain in adolescents and young adults. Future reliability studies may include a balanced group for classifications or a second session.
研究机械诊断与治疗（MDT）认证医师在青少年和年轻成年人腰痛分类中的组内一致性。
43 名参与者（平均年龄 15 ± 2 岁）有腰痛，伴有或不伴有下肢症状，由三位 MDT 认证医师同时评估，并分为三组之一：1）紊乱，2）功能障碍，3）姿势/其他。采用 Fleiss kappa 统计量（95%置信区间）计算组内一致性。对年龄较小（11 至 15 岁）和年龄较大（16 至 21 岁）的年龄组进行了重复分析。
整个样本的可靠性为中度（Fleiss kappa = 0.50，95%CI = 0.45 至 0.54），具有统计学意义（p < 0.001）。年龄较大的参与者的可靠性良好（Fleiss kappa = 0.63，95%CI = 0.57 至 0.70），而年龄较小的参与者的可靠性较差（Fleiss kappa = 0.33，95%CI = 0.27 至 0.39）。评估者在 70%的参与者中达成了 100%的分类共识。
MDT 系统在青少年和年轻成年人腰痛分类中具有中度可靠性。未来的可靠性研究可能包括平衡的分类组或第二次评估。
