The inter-examiner reliability of a classification method for non-specific chronic low back pain patients with motor control impairment

The importance of classifying chronic low back pain (LBP) patients into homogeneous sub-groups has recently been emphasized. This paper reports on two studies examining clinicians ability to agree independently on patients’ chronic LBP classification, using a novel classification system (CS) propose...

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Bibliographic Details
Published in:Manual therapy 2006-02, Vol.11 (1), p.28-39
Main Authors: Dankaerts, W., O’Sullivan, P.B., Straker, L.M., Burnett, A.F., Skouen, J.S.
Format: Article
Language:English
Subjects:
Adult
Agreement
Australia
Chronic low back pain
Classification
Clinical Competence
Female
Humans
Low Back Pain - classification
Low Back Pain - diagnosis
Low Back Pain - therapy
Middle Aged
Motor Activity
Motor control impairment
Movement Disorders - classification
Movement Disorders - diagnosis
Musculoskeletal Manipulations - methods
Musculoskeletal Manipulations - organization & administration
Norway
Observer Variation
Outcome Assessment (Health Care) - methods
Physical Examination - methods
Physical Therapy Modalities
Predictive Value of Tests
Reliability
Reproducibility of Results
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Summary:The importance of classifying chronic low back pain (LBP) patients into homogeneous sub-groups has recently been emphasized. This paper reports on two studies examining clinicians ability to agree independently on patients’ chronic LBP classification, using a novel classification system (CS) proposed by O’Sullivan. In the first study, a sub-group of 35 patients with non-specific chronic LBP were independently classified by two ‘expert’ clinicians. Almost perfect agreement (kappa-coefficient 0.96; %-of-agreement 97%) was demonstrated. In the second study, 13 clinicians from Australia and Norway were given 25 cases (patients’ subjective information and videotaped functional tests) to classify. Kappa-coefficients (mean 0.61, range 0.47–0.80) and %-of-agreement (mean 70%, range 60–84%) indicated substantial reliability. Increased familiarity with the CS improved reliability. These studies demonstrate the reliability of this multi-dimensional mechanism-based CS and provide essential evidence in a multi-step validation process. A fully validated CS will have significant research and clinical application.
ISSN:1356-689X
1532-2769
DOI:10.1016/j.math.2005.02.001