Van Dillen L R, Sahrmann S A, Norton B J, Caldwell C A, Fleming D A, McDonnell M K, Woolsey N B
Program in Physical Therapy, Washington University School of Medicie, St Louis, MO, USA.
Phys Ther. 1998 Sep;78(9):979-88. doi: 10.1093/ptj/78.9.979.
The purpose of this study was to examine the interrater reliability of measurements obtained by examiners administering tests proposed to be important for classifying low back pain (LBP) problems.
Ninety-five subjects with LBP (41 men, 54 women) and 43 subjects without LBP (17 men, 26 women) were examined by 5 therapists trained in the techniques used.
A manual was developed by the first author that described the clinical examination procedures. The therapists were trained by the first author in the test procedures and definitions. The training included instruction through videotapes, practice and a written examination. Each examination was conducted by a pair of therapists. Within a pair, a therapist was the primary examiner for half of the subjects and an observer was the primary examiner for half of the subjects. Examination findings were recorded independently, without discussion.
Percentage of agreement and generalized kappa coefficients were used to analyzed the data. Kappa values were > or = .75 for all 28 items related to the symptoms elicited and > or = .40 for 72% of the 25 items related to alignment and movement.
The results suggest that experienced therapist who had trained together were able to agree on the results of examinations and obtain an acceptable level of reliability. Future work should focus on testing of reliability when more than one therapist performs the examination and when therapist not trained by the test developer to administer the examination perform the tests. [Van Dillen LR, Sahrmann SA, Norton BJ, et al. Reliability of physical examination items used for classification of patients with low back pain.
本研究旨在检验由考官进行的测量的评分者间信度，这些考官实施了被认为对下腰痛（LBP）问题分类很重要的测试。
95名下腰痛患者（41名男性，54名女性）和43名无下腰痛的受试者（17名男性，26名女性）接受了5名接受过所用技术培训的治疗师的检查。
第一作者编写了一本描述临床检查程序的手册。治疗师由第一作者进行测试程序和定义方面的培训。培训包括通过录像带进行指导、实践和书面考试。每次检查由一对治疗师进行。在一对治疗师中，一名治疗师是一半受试者的主考官，另一名是另一半受试者的主考官。检查结果独立记录，不进行讨论。
使用一致性百分比和广义kappa系数分析数据。与引出症状相关的所有28项的kappa值均≥0.75，与对线和运动相关的25项中72%的kappa值≥0.40。
结果表明，一起接受培训的有经验的治疗师能够就检查结果达成一致，并获得可接受的信度水平。未来的工作应侧重于在不止一名治疗师进行检查时以及未由测试开发者培训来实施检查的治疗师进行测试时的信度测试。[范迪伦LR，萨赫曼SA，诺顿BJ等。用于下腰痛患者分类的体格检查项目的信度。
