Agreement among physiotherapists in assessing patient performance of exercises for low-back pain

Abstract

BackgroundThere is no agreement for the performance assessment of patients who practice exercises.. (2 points to withdraw) This assessment is currently left to the physiotherapist’s personal judgement. We studied the agreement among physiotherapists in rating patient performance during exercises recommended for chronic low-back pain (LBP).MethodsA vignette-based method was used. We first identified ten exercises recommended for LBP in the literature. Then, 42 patients with chronic LBP participating in a rehabilitation program were videotaped during their performance of one of the ten exercises. A vignette was an exercise video preceded by clinical information. Ten physiotherapists from primary (4) and tertiary care (6) viewed the 42 vignettes twice, one month apart, and rated patient performance from zero (worse performance) to ten (excellent performance) by considering the position and duration of the contraction or stretching. Intra-class correlation coefficients (ICCs) and 95% confidence intervals (95% CIs) were computed to assess inter- and intra-rater reliability.ResultsThe overall inter-rater agreement was fair (ICC 0.48 [95% CI 0.33–0.56]) but was better for stretching exercises (0.55 [0.35–0.64]) than strengthening exercises (0.42 [0.20–0.52]) and for tertiary-care physiotherapists (0.66 [0.54–0.76]) than primary-care physiotherapists (0.28 [0.09–0.37]). The intra-rater agreement was overall good (0.72 [0.57–0.81] to 0.88 [0.79–0.94]). It was better for stretching exercises (from 0.68 [0.46–0.81] to 0.96 [0.91–0.98]) than strengthening exercises (from 0.68 [0.38–0.84]) to 0.82 [0.56–0.92]).ConclusionThe agreement in rating patient performance of exercises for LBP is good among physiotherapists trained in managing LBP but is low among non-trained physiotherapists.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2173-9) contains supplementary material, which is available to authorized users.

Measuring exercise adherence in patients with low back pain: development, validity, and reliability of the EXercise Adherence Scale (EXAS)

“…The results for interrater reliability of the EXAS quality of performance are poor. This finding is almost identical to the results of Hermet et al (2018), who found an interrater reliability of 0.34 (95%-CI 0.07-0.48) for primary care physical therapists rating strength exercises. They proposed that different backgrounds and expectations between physical therapists might be the cause of low interrater reliability, as higher reliability scores were found in trained physical therapists.…”

“…With this score, the reliability estimate exceeds the standard threshold of 0.70 for use as a between-groups comparison measure (Frost et al, 2007). This result is very similar to the intrarater reliability results found in a study using a 10-point rating scale (Hermet et al, 2018). Of the six physical therapists rating patient quality of performance using this 10-point scale, four scored between 0.82 and 0.88, with the remaining two scoring 0.72 and 0.74, respectively.…”

“…The primary difference between this study and the current study is the scale on which quality of the performance was rated. In the study by Hermet et al (2018), a 10point rating scale was used, whereas, in the current study, a 5-point ordinal scale with additional explanation was used to provide a more standardized means of interpreting the different ratings.…”

Evaluation of the impact of a smartphone application on adherence to home exercise program for people with chronic low back pain: research protocol for a pilot randomised controlled trial

“…Pain intensity during the last 7 days will be measured on a Numeric Rating Scale (NRS). Adherence will also be evaluated qualitatively using a video created by the individual on which they summarise the physical exercise they performed during rehabilitation care, a graded evaluation grid will be used to rate adherence 50. They will also film themselves performing three physical exercises (squat, plank and rowing) and the qualitative adherence will be measured by a graded evaluation grid.…”