Inter-tester reliability of discriminatory examination items for sub-classifying non-specific low back pain.

OBJECTIVE To investigate the inter-tester reliability of a non-specific low back pain examination procedure, for sub-classifying non-specific low back pain. DESIGN Reliability study. PARTICIPANTS Thirty patients with non-specific low back pain (12 males, 18 females, mean age: 27.7 years (standard deviation 10.3) and 7 physiotherapists (raters). METHODS Based on a health professionals' consensus via focus groups and a Delphi servey, an examination procedure was developed comprising 206 items discriminatory for non-specific low back pain, 108 of which were from the History (clinical questions) and 98 from the Physical Examination (clinical tests) section. Utilizing this procedure, each patient was examined by a blinded pair of raters. RESULTS Moderate to excellent agreement was obtained in 125 (61%) items (77 History and 48 Physical Examination items), 47 of which obtained substantial or excellent agreement (kappa >0.61), 37 moderate agreement (kappa between 0.41 and 0.6), and 41 excellent percentage agreements. Poor reliability (kappa < 0.41) was yielded in the remaining 81 items (31 History and 50 Physical Examination items). CONCLUSION Satisfactory reliability was obtained in nearly two-thirds of History and half of the Physical Examination items on a non-specific low back pain assessment list generated through consensus agreement. These findings provide clinicians and researchers with valuable information regarding which items are considered reliable and can be utilized in non-specific low back pain patient evaluation/assessment procedures, classification attempts and clinical trials.