Reliability of Tests for Low Back PainOnly a very small number of back pain patients have a serious condition such as a fracture, infection, or tumor. More than 90 per cent of patients with low back pain (LBP) have nerve impingement or some other mechanical problem.
Many LBP patients are examined first by a health care professional who is not a doctor. Physical therapists (PTs) are often the first contact for LBP patients.
When examining someone with LBP, physical therapists (PTs) often use questions and physical tests in a process called triage. This clinical exam helps identify the problem. The therapist can then apply the best treatment for the problem at hand.
In this study, researchers measured the reliability of the tests used by PTs in the exam. If the tests aren't reliable, then the results aren't valid or helpful. Over 300 patients with acute or chronic back pain were included. Each patient saw two PTs one at a time, an hour apart.
Each therapist conducted a series of 50 questions and tests on the same patient but didn't know the other therapist's test results. This is called interrater reliability. The researchers were looking at the interrater reliability to see if the tests were valuable measurement tools.
They found that 86 per cent of the questions and tests had fair agreement or better. Five questions about the pain and other symptoms had poor agreement. Two tests (prone knee bend and myotome testing) had poor interrater reliability.
Refining the initial diagnostic or triage process is important with back pain patients. This study to evaluate the validity of tests often used with LBP patients focused on intertester reliability. Most of the tests were useful but a couple can be tossed out as unreliable.
The next step is to analyze the test results. There may be clusters of signs and symptoms that respond better to one type of treatment over another. Identifying which tests are best for each cluster may help speed up the diagnostic process.
Christopher James McCarthy, PhD, et al. The Reliability of the Clinical Tests and Questions Recommended in International Guidelines for Low Back Pain. In Spine April 15, 2007. Vol. 32. No. 8. Pp. 921-926.
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