Mayer R S, Chen I H, Lavender S A, Trafimow J H, Andersson G B
Department of Physical Medicine and Rehabilitation, Rush Medical College, Chicago, Illinois, USA.
Spine (Phila Pa 1976). 1995 Jul 1;20(13):1489-93. doi: 10.1097/00007632-199507000-00008.
Repeated measurements were made of lumbar sagittal range of motion by 14 examiners using three different measurement instruments.
To determine the reliability of lumbar range of motion measurements among examiners, subjects, and instruments, and to determine whether variance is due to subject inconsistency, examiner inconsistency, differences between examiners, or differences between instruments.
Measurements of lumbar spine range of motion are widely used in research and clinical applications as well as in disability rating systems for patients with low back pain.
Fourteen examiners measured the sagittal range of motion. Using three instruments, 18 healthy subjects were measured twice in a randomized sequence with blinded readings when performing full flexion, and partial flexion to a defined midpoint. None of the examiners routinely used the particular instruments in their practices.
The mean test-retest reliability was 4.9 degrees. The intraexaminer reliability did not differ significantly among the examiners. Furthermore, there was no systematic difference resulting from instruments or posture condition. However, there was a statistically significant variance among examiners--i.e., a poor interexaminer reliability.
The most likely explanation for these findings is the variability among examiners in locating bony landmarks. The results indicate that range of motion measurements must be interpreted with caution in clinical, research, and disability applications. Test administrator training may improve results, but this could not be determined from this study.
14名检查者使用三种不同的测量仪器对腰椎矢状面活动度进行重复测量。
确定检查者、受试者和仪器之间腰椎活动度测量的可靠性，并确定差异是否归因于受试者不一致、检查者不一致、检查者之间的差异或仪器之间的差异。
腰椎活动度测量广泛应用于研究、临床以及腰痛患者的残疾评定系统。
14名检查者测量矢状面活动度。使用三种仪器，对18名健康受试者在进行全屈和屈至特定中点的部分屈曲时，以随机顺序进行两次测量，测量时读数 blinded。没有检查者在其日常工作中常规使用这些特定仪器。
重测信度的均值为4.9度。检查者内部的可靠性在检查者之间没有显著差异。此外，仪器或姿势条件没有导致系统性差异。然而，检查者之间存在统计学上显著的差异——即检查者间信度较差。
这些发现最可能的解释是检查者在确定骨性标志位置时存在变异性。结果表明，在临床、研究和残疾评定应用中，必须谨慎解释活动度测量结果。测试管理员培训可能会改善结果，但本研究无法确定这一点。
