The inter-rater reliability of clinical tests that best predict the subclassification of lumbar segmental instability: structural, functional and combined instability

Abstract

Objectives: This study investigated the inter-rater reliability of three structural end range lumbar segmental instability tests with the highest positive likelihood ratio ( z LR) against flexion-extension radiographs, and three functional mid-range clinical tests that predict the success of lumbar stabilisation exercises in patients with recurrent or chronic low-back pain (R/CLBP). The study also investigated the reliability of lumbar segmental instability, subclassification as: functional, structural and combined instability. Method: Forty adults with R/CLBP (30 men and 10 women), aged 21-71 years, underwent repeated measurements of specific clinical tests for structural or functional lumbar segmental instability. Results: All functional-instability tests: the prone instability test (PIT), the aberrant motion test and the average passive straight-leg raise (PSLRw91u u) test showed a high percentage agreement (90, 97?5 and 95%, respectively) and a high kappa coefficient (0?71, 0?79 and 0?77, respectively). In addition, two structural tests: the lumbar flexion range of motion (ROM) w53u u and the passive lumbar extension test (PLET) showed a high percentage agreement (82 and 73%, respectively), and a moderate kappa coefficient (0?48 and 0?46, respectively). The lack of hypomobility with the posteroanterior (PA) glide test was found to be unreliable (agreement525%; k5{0?02). Locating the pain-provoking segment, as the first portion of PIT, was found to be moderately reliable (k50?41). The subclassification categories of lumbar segmental instability (functional, structural and combined) were found to be significantly reliable (PABAK) 0?90, 0?70 and 0?95, respectively). Discussion: All investigated tests (except the lack of hypomobility with the PA glide test), in addition to subclassifying the categories of lumbar segmental instability, were significantly reliable in the assessment of lumbar instability.

Reliability and validity of manual palpation for the assessment of patients with low back pain: a systematic and critical review

“…We critically appraised 16 articles and 14 articles had low risk of bias and were included in our evidence synthesis [19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Fig. 1).…”

“…Fourteen articles had a low risk of bias [19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Of those, 11 reported on the reliability of palpation tests [19][20][21][22][23][24][25][26][27][28][29] and six reported on validity [22,[28][29][30][31][32]. Three articles examined both reliability and validity [22,28,29].…”

“…The 14 low risk of bias articles investigated: 1) static joint palpation (n = 7) [19,21,23,25,26,29,31], 2) motion joint palpation (n = 3) [20,27,32], and 3) static soft tissue palpation (n = 5) [22,24,[28][29][30] (Tables 3 and 4). They assessed various techniques: 1) joint pain provocation [19,21,23,26,29], 2) pain or tenderness of muscles [24,29,30], 3) pain and tenderness of nerves [28], 4) joint stiffness/mobility [19,21,23,25,26,31], 5) joint motion [20,27,32], and 6) isometric muscle contraction [22]. Table 5 showed a glossary of definitions for all of the palpation tests included in the articles.…”

Lumbar spondylolisthesis: STATE of the art on assessment and conservative treatment

“…Concerning lumbar passive motion, the Posterior Shear Test [PST], also called the Segmental Spring Test or Passive Intervertebral Movement Test, aims to identify segmental hypermobility and/or provoke pain through passive posterior-anterior mobilization of the SPL level. This test demonstrated fair inter-examiner reliability, with k values from − 0.02 to 0.27 [ 56 , 57 ]. Its specificity appeared generally high with values from 0.81 to 0.95 (positive likelihood ratios from 2.42 to 9.00), whereas its sensitivity was poor with values ranging from 0.17 to 0.46 (negative likelihood ratios from 0.60 to 0.88) [ 58 ].…”

Diagnostic efficacy of clinical tests for lumbar spinal instability

“…Lumbar spinal instability (LSI) is a common cause of nonspecific low back pain (LBP). [ 1 ] At present, flexion-extension X-rays are the standard method for measuring anteroposterior translation[ 2 4 ] but have several shortcomings. [ 2 ] There are several clinical tests for diagnosing LSI,[ 1 2 3 5 ] however, none have been previously proven to be effective measures for LSI.…”