Donahue M S, Riddle D L, Sullivan M S
Department of Physical Therapy, School of Allied Health Professions, Virginia Commonwealth University, Richmond 25298, USA.
Phys Ther. 1996 Jul;76(7):706-16; discussion 717-26. doi: 10.1093/ptj/76.7.706.
McKenzie described a two-step process for assessing patients with low back pain for a lateral shift. The purpose of this study was to determine whether reliable judgments about lateral shifts could be obtained.
Forty-nine patients with low back pain were each examined separately by two randomly paired physical therapists.
Assessments of the presence and direction of lateral shifts (step 1) were obtained by use of a simple instrument. The relevance of the lateral shifts to the patients' pain complaints (step 1) also was assessed by use of the side-glide test sequence.
Generalized kappa coefficients were calculated to determine reliability. The kappa value for the two-step process of lateral shift assessment was .16. The percentage of agreement was 47%.
Each step in this two-step process was examined separately for possible sources of error. The kappa value for determinations of the presence and direction of lateral shifts was .00, indicating very poor reliability. The kappa value for the determination of the presence of a positive side-glide test sequence was .74, indicating high reliability. The role of lateral shift assessment in the McKenzie system should be reconsidered, given the strong research evidence for poor reliability of determinations of the presence and direction of lateral shifts.
麦肯齐描述了一个用于评估下背痛患者是否存在侧方移位的两步法。本研究的目的是确定对于侧方移位能否做出可靠的判断。
49名下背痛患者由两名随机配对的物理治疗师分别进行检查。
使用一种简单器械评估侧方移位的存在及方向（第一步）。还通过侧方滑动试验序列评估侧方移位与患者疼痛主诉的相关性（第一步）。
计算广义kappa系数以确定可靠性。侧方移位评估两步法的kappa值为0.16。一致性百分比为47%。
分别检查了这个两步法中每一步可能的误差来源。侧方移位存在及方向判定的kappa值为0.00，表明可靠性非常差。侧方滑动试验序列阳性判定的kappa值为0.74，表明可靠性高。鉴于有强有力的研究证据表明侧方移位存在及方向判定的可靠性差，应重新考虑侧方移位评估在麦肯齐系统中的作用。
