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Study Design: A prospective methodological interrater reliability study. Objectives: To calculate the interrater reliability among clinicians newly trained in a classification system for acute low back pain and to determine the level of agreement at key junctures within the classification algorithm. Background: The utility of a classification system for patients with low back pain depends on its reliability and generalizability. To be practical, clinicians must be able to apply the system after a reasonable amount of training. Identifying key points in the classification algorithm where disagreement occurs can lead to better operational definitions. Methods: Four physical therapists read an article and attended a 1-day training session in the classification system. Randomly paired therapists classified patients referred for treatment of acute low back pain and noted decisions at key junctures in the system algorithm. Results: Forty-five patients were classified. Repeated examinations did not increase the patient's pain (P Ͼ.05). For 3 out of the 4 therapists, the interrater reliability showed a kappa value of 0.45. The fourth therapist, excluded from the overall analysis, exhibited a bias towards the immobilization classification. Among the 3 therapists, major disagreement occurred with the determination of symmetry with trunk side bending and the effects of repeated movements. Conclusions: Three out of 4 clinicians newly trained in the system showed moderate reliability. The reliability was slight when the fourth therapist was included. Refinement of the operational definitions and criteria for determining lumbar capsular patterns are needed. One day of training is probably not adequate for all therapists, especially for those biased towards specific low back pain syndromes.

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To quantify the pain-related impairment (PRI) of elderly individuals with COPD and chronic pain using the self-reported Pain Disability Questionnaire (PDQ), obtained from the AMA Guides to the Evaluation of Permanent Impairment Sixth Edition, and to investigate the correlation between the PRI status and scores from clinician-derived Physical Performance Tests (PPT). Design: Retrospective cross-sectional study. Setting: Medicare-accredited comprehensive outpatient rehabilitation facility. Participants: 29 elderly community-dwelling subjects with mild to severe COPD reporting chronic pain. Interventions: Not applicable. Main Outcome Measures: The Self-Administered Co-Morbidity Questionnaire (SCQ), identified individuals with chronic pain. The 15-item PDQ was scored on a 10-point scale, for a maximum total score of 150 (high pain and disability) and a minimum score of 0: mild (0-70); moderate (71-100); severe (101-130); and extreme (131-150). The 6-Minute Walk Test (6MWT), Berg Balance Scale, and Dynamic Gait Index (DGI) were used as PPT. Pearson correlation coefficients (r) were used to examine associations between total PDQ and PPT results. An alpha of .10 was used for statistical tests. Results: Total PDQ, when divided into subcategories of PRI severity, resulted in 67% mild; 27% moderate; 3% severe; and 3% extreme PRI. A statistically significant negative correlation was found between the total PDQ score and Berg Balance Scale (rϭϪ.373, Pϭ.047), 6MWT (rϭϪ.318, Pϭ.093), and DGI (rϭϪ.328, Pϭ.082). Conclusions: The majority of COPD outpatients scored in the mild PRI category, and this PRI had a statistically significant negative effect on PPT scores. These findings suggest that the self-reported PDQ is a reliable indicator of physical performance status, and would be valuable as an alternative to PPT in a busy clinical practice. The PDQ is a valid, subjective report and further research into its application among other patient populations, such as poly-trauma cases, would be beneficial.