Binkley J, Stratford P W, Gill C
Department of Physical Therapy, North Georgia College, Dahlonega 30597, USA.
Phys Ther. 1995 Sep;75(9):786-92; discussion 793-5. doi: 10.1093/ptj/75.9.786.
This study examined the interrater agreement, or reliability, of accessory motion mobility testing of the lumbar spine in patients with low back pain.
Subjects were 18 patients with low back pain referred to the physical therapy outpatient department of a university teaching hospital.
Six orthopedic physical therapists evaluated the posterior-anterior (P-A) accessory motion mobility at each of six levels, L-1 to the sacral base, on each subject. The mobility was recorded on a nine-point scale, and reproduction of pain was noted. The physical therapists noted any level at which mobility or pain findings were of significance to treat. To evaluate agreement on the identification of spinal levels, therapists were asked to identify one spinous process, which was arbitrarily marked on each subject. Kappa analyses and intraclass correlation coefficients (ICCs) were calculated to evaluate agreement on the level of the marked segment and the mobility at that level, respectively.
The ICC for determination of the marked level was R(2,1) = .69 (95% confidence interval = .53-.82). The ICC for mobility findings at the marked level was R(2,1) = .25 (95% confidence interval = 0-.44). A secondary Kappa analysis to determine agreement on treatment decision making demonstrated similarly low levels of agreement.
There is poor interrater agreement on determination of the segmental level of a marked spinous process. There is poor interrater reliability of P-A accessory mobility testing in the absence of corroborating clinical data. Caution should be exercised when physical therapists make clinical decisions related to the evaluation of motion at a specific spinal level using P-A accessory motion testing.
本研究检测了下腰痛患者腰椎附属运动活动度测试的评定者间一致性或可靠性。
18名下腰痛患者被转至一所大学教学医院的物理治疗门诊。
6名骨科物理治疗师对每名受试者从L-1至骶骨基部的6个节段进行后前（P-A）附属运动活动度评估。活动度以九点量表记录，并记录疼痛再现情况。物理治疗师记录任何活动度或疼痛发现具有治疗意义的节段。为评估对脊柱节段识别的一致性，要求治疗师识别每个受试者上任意标记的一个棘突。分别计算kappa分析和组内相关系数（ICC），以评估对标记节段水平及该水平活动度的一致性。
确定标记节段水平的ICC为R(2,1) = .69（95%置信区间 = .53-.82）。标记节段水平活动度结果的ICC为R(2,1) = .25（95%置信区间 = 0-.44）。用于确定治疗决策一致性的二次kappa分析显示一致性水平同样较低。
在确定标记棘突的节段水平方面，评定者间一致性较差。在缺乏确证临床数据的情况下，P-A附属运动活动度测试的评定者间可靠性较差。当物理治疗师使用P-A附属运动测试对特定脊柱节段的活动度评估做出临床决策时，应谨慎行事。
