Interrater and intrarater reliability of the active hip abduction test

Clinical tests predictive of temporary low back pain development during the prolonged standing test in physical therapy students

Low back pain among physical therapists is a common musculoskeletal disorder that first occurs early in their career or as a student. This observational prospective study assessed the ability of hip and lumbopelvic neuromuscular control, endurance and hip range of motion tests to predict the development of transient low back pain development during a standing task. Seventy-two physical therapy students without low back pain completed nine performance tests and a 2-hour standing test on two separate days. Participants were classified as transient pain developers (PD) if they reported a ≥ 10mm increase in low back pain on a visual analog scale. Transient back pain was reported by 37.5% of students during the standing test. A cluster of three positive tests, self-rated active hip abduction (somewhat difficult or more), bilateral total hip internal rotation greater than 81 degrees, and non-dominant limb single-leg squat (moderate deviations), demonstrated an increased probability (94.9%) of identifying PDs. Negative findings on the same three tests decreased the probability to 10.7%. Overall, the classification accuracy for the three-test model was 72.2%. The sensitivity for the model was 63% and the specificity was 77.8%.

Functional Tests Predicting Return to Work of Workers with Non-Specific Low Back Pain: Are There Any Validated and Usable Functional Tests for Occupational Health Services in Everyday Practice? A Systematic Review

The literature predominantly advocates subjective perception of disability and pain as an outcome measure for the functional evaluation of patients with low back pain (LBP). Physical outcome measurements are almost completely ignored. In this systematic review, we focused on physical functional measurements that can contribute to the prediction of patients' return to work (RTW) readiness after sick leave or rehabilitation. Searches were conducted in July 2022 without any time limit in the Cochrane Library, PEDro, PubMed and Scopus databases for functional and clinical tests reliable and applicable in clinical practice without demanding equipment. Two independent researchers extracted the data from the included articles in a standardised data collection form, and a third researcher validated the data extraction. No date restriction was applied. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in conducting the review. We found seven original articles, including six with an impact on predicting RTW. We found four fair and three poor original studies fulfilling our criteria. We found the Back Performance Scale (BPS) and back endurance test to be the most promising tests for occupational health service and the clinical practitioner. Radiation of back pain, with or without neurological deficiencies, had some predictive value in terms of RTW, too. The working conditions vary a lot, which causes inconsistency in the studies and in their interpretation. Functional tests could complete the widely used working ability evaluations methods such as the Work Ability Index (WAI) and are worth considering for future research. Overall, more research is needed in this field. The question of when LBP patients can resume everyday activities and work is not possible to determine with functional tests alone. Psychosocial aspects and work demands must be considered. PROSPERO: CRD42022353955. The study was funded by the University of Helsinki.

Intrarater and interrater agreement of a 6-item movement control test battery and the resulting diagnosis in patients with nonspecific chronic low back pain

OBJECTIVE

To investigate the intrarater and interrater agreement of a 6-item test battery in nonspecific chronic low back pain (LBP) and investigate the agreement between raters to assign the resulting movement control (MC) diagnoses.

METHODS

Thirty patients with chronic LBP (18-30 years) were included in this study. Six raters were trained and rated the videos of the patients during the execution of the tests. After one week, the raters re-watched the videos and repeated the examination. A diagnosis of MC was assigned for each patient. Agreement was analyzed using weighted kappa and prevalence-adjusted and bias-adjusted kappa (PABAK) coefficients.

RESULTS

We showed an acceptable intrarater agreement for the 6-item test battery for four out of six raters, except for one test: prone knee flexion. The results of the interrater agreement between the three pairs of raters showed acceptable agreement levels (k > 0.4), except for two tests, "rocking on all four backward" and "prone knee flexion test." For the diagnosis of MC impairment, acceptable agreement levels (k > 0.4) were observed for five out of six raters for intrarater agreement. For interrater assessment, we found an acceptable agreement between pairs of raters.

CONCLUSION

We showed acceptable levels of agreement between the intrarater and interrater for a 6-item test battery to identify MC impairment, except for two tests. Agreement in the MC diagnoses achieved acceptable levels for five of the six raters (intrarater) and all three pairs of raters (interrater). Such results support the use of the 6-item test battery to detect MC impairment.

Thirty Minutes Identified as the Threshold for Development of Pain in Low Back and Feet Regions, and Predictors of Intensity of Pain during 1-h Laboratory-Based Standing in Office Workers

This study with 40 office workers investigated (a) the effect of time spent standing on low- back and lower limb pain during a 1-h laboratory-based task; (b) the standing time after which a significant increase in pain is likely; and (c) the individual, physical and psychosocial factors that predict pain. The primary outcome was bodily location of pain and pain intensity on a 100-mm Visual Analogue Scale recorded at baseline and every 15 min. Physical measures included trunk and hip motor control and endurance. Self-report history of pain, physical activity, psychosocial job characteristics, pain catastrophizing and general health status were collected. Univariate analysis and regression models were included. The prevalence of low-back pain increased from 15% to 40% after 30 min while feet pain increased to 25% from 0 at baseline. The intensity of low-back and lower limb pain also increased over time. A thirty-minute interval was identified as the threshold for the development and increase in low-back and feet pain. Modifiable factors were associated with low-back pain intensity-lower hip abductor muscle endurance and poorer physical health, and with feet symptoms-greater body mass index and less core stability.

Patterns of balance loss with systematic perturbations in Parkinson's disease and multiple sclerosis

BACKGROUND:

Multiple sclerosis (MS) and Parkinson’s disease (PD) may affect balance differently. However, no studies have compared loss of balance (LOB) patterns following multi-directional perturbations.

OBJECTIVE:

1) determine reliability of LOB ratings following standardized manual perturbations; 2) compare LOB ratings in MS, PD, and healthy control (HC) groups following perturbations at upper/lower torso, in anterior/posterior, right/left, and rotational directions.

METHODS:

1) reviewers rated videotaped LOB following perturbations applied by 4 clinicians in 6–10 HCs. 2) three groups (64 MS, 42 PD and 32 HC) received perturbations. LOB ratings following perturbations were analyzed using two-factor mixed ANOVAs for magnitude and prevalence.

RESULTS:

1) LOB ratings showed moderate to good ICC and good to excellent agreement. 2) MS group showed greater magnitude and prevalence of LOB than PD or HC groups (p < .001). All groups showed greater LOB from right/left versus anterior/posterior perturbations (p < .01). PD showed greater LOB from perturbations at upper versus lower torso; MS and HC showed greater LOB from posterior versus anterior perturbations.

CONCLUSIONS:

Our reliable rating scale showed differences in patterns of LOB following manual perturbations in MS, PD, and HC. Clinically accessible and reliable assessment of LOB could facilitate targeted perturbation-based interventions and reduce falls in vulnerable populations.

Trunk muscle activation patterns during active hip abduction test during remission from recurrent low back pain: an observational study

Background

The active hip abduction test (AHAbd) is widely used to evaluate lumbopelvic stability, but the onset of trunk muscle activation during the test in individuals with recurrent low back pain (rLBP) has not been investigated so far. It is important to investigate the pattern of trunk muscle activation during the AHAbd test to provide insight into the interpretation of observation-based assessment results; this may help to create exercise therapy interventions, from a movement control perspective, for people seeking treatment for rLBP. The purpose of this study was to compare the timing of trunk muscle activation between individuals with and without rLBP and to assess potential differences.

Methods

Seventeen subjects in remission from rLBP and 17 subjects without rLBP were recruited. We performed surface electromyography of the transversus abdominis/internal abdominal oblique, external oblique, erector spinae, and gluteus medius muscles during the AHAbd test on both sides. The onset of trunk muscle activation was calculated relative to the prime mover gluteus medius. The independent-samples t- and Mann-Whitney U tests were used to compare the onset of trunk muscle activation between the two groups.

Results

The onset of transversus abdominis/internal abdominal oblique activation on the ipsilateral (right AHAbd: −3.0 ± 16.2 vs. 36.3 ± 20.0 msec, left AHAbd: −7.2 ± 18.6 vs. 29.6 ± 44.3 ms) and contralateral sides (right AHAbd: −11.5 ± 13.9 vs. 24.4 ± 32.3 ms, left AHAbd: −10.1 ± 12.5 vs. 23.3 ± 17.2 ms) and erector spinae on the contralateral side (right AHAbd: 76.1 ± 84.9 vs. 183.9 ± 114.6 ms, left AHAbd: 60.7 ± 70.5 vs. 133.9 ± 98.6 ms) occurred significantly later in individuals with rLBP than in individuals without rLBP (p < 0.01). During the left AHAbd test, the ipsilateral erector spinae was also activated significantly later in individuals with rLBP than in individuals without rLBP (71.1 ± 80.1 vs. 163.8 ± 120.1 ms, p < 0.05). No significant difference was observed in the onset of the external oblique activation on the right and left AHAbd tests (p > 0.05).

Conclusions

Our results suggest that individuals with rLBP possess a trunk muscle activation pattern that is different from that of individuals without rLBP. These findings provide an insight into the underlying muscle activation patterns during the AHAbd test for people with rLBP and may support aggressive early intervention for neuromuscular control.

[Function-based tests to determine the return-to-activity state in patients with non-specific low back pain]

BACKGROUND

 Most people with back pain suffer from non-specific low back pain, for which no specific reasons can be found. Two out of three have recurrent pain episodes. To reduce the likelihood of recurrence and long-lasting pain, functional tests are increasingly used to determine the current functional status. This literature study evaluates evidence of functional tests in patients with non-specific low back pain and their validity related to the return-to-activity (RTA) status. The objective of this analysis is to give recommendations for specific activities and to assess the risk of chronification and recurrent pain.

METHODS

 PubMed-based literature search. Narrative review focusing on data from the past ten years.

RESULTS

 A total of twelve studies were included in the analysis. Overall, 33 different tests were identified for which positive statements regarding reliability, validity and relevance for the assessment of the RTA status in non-specific back pain could be made. The tests identified may be able to provide useful information when assessing the RTA status and to recognise yellow and blue flags in patients with non-specific low back pain. The ability to walk, the behaviour when lifting and carrying objects, motor control, muscle strength and mobility play a particular role.

CONCLUSION

 The determination of the RTA status in patients with non-specific low back pain should be patient-specific and based on biopsychosocial aspects rather than relying exclusively on movement-related tests. Exact statements regarding the point in time when patients can resume everyday activities and work without an increased risk of recurrence or chronicity do not seem possible with functional tests alone. The major influence of psychological and social factors on disease development, course and prognosis are limiting factors. Movement and strain-related tests can still be used to evaluate activities related to everyday life, to design therapy programs and to give patients confidence.

What Psychosocial and Physical Characteristics Differentiate Office Workers Who Develop Standing-Induced Low Back Pain? A Cross-Sectional Study

This study examines demographic, physical and psychosocial factors associated with an increase in low back pain (LBP) during a one-hour standing task. A cross-sectional survey with 40 office workers was conducted. The primary outcome was pain severity during a one-hour standing task recorded every 15 min using a 100 mm Visual Analogue Scale (VAS). Participants were defined as pain developers (PD), if they reported a change in pain of ≥10 mm from baseline, or non-pain developers (NPD). Physical outcomes included participant-rated and examiner-rated trunk and hip motor control and endurance. Self-report history of LBP, physical activity, psychosocial job characteristics, general health and pain catastrophising were collected. Fourteen participants were PD. Hip abduction, abdominal and spinal muscle endurance was lower for PD (p ≤ 0.05). PD had greater self-reported difficulty performing active hip abduction and active straight leg raise tests (p ≤ 0.04). Those reporting a lifetime, 12 month or 7-day history of LBP (p < 0.05) and lower self-reported physical function (p = 0.01) were more likely to develop LBP during the standing task. In conclusion, a history of LBP, reduced trunk and hip muscle endurance and deficits in lumbopelvic/hip motor control may be important to consider in office workers experiencing standing-induced LBP.

Individuals with low back pain improve in standing tolerance and sagittal plane muscle activation following exercise intervention

BACKGROUND

Healthy individuals who develop low back pain (LBP) during standing (standing intolerant) respond favorably to stabilization-based exercise interventions. People with clinical LBP meeting clinical prediction rules for stabilization-based exercise share characteristics with standing intolerant individuals.

OBJECTIVE

To investigate the impact of stabilization-based exercise on standing tolerance, muscle activation and clinical measures in individuals with LBP meeting clinical prediction rules for stabilization-based exercise.

METHODS

Participants with and without LBP completed testing pre- and post-6 weeks of progressive home exercise intervention. Testing included clinical examination and electromyography during sagittal and frontal plane movements. LBP was also assessed by visual analogue scale (VAS) during standing. Outcomes included clinical findings, muscle sequencing, and VAS in standing.

RESULTS

The LBP group had non-significant decreases in Oswestry Disability Index (-2.1%, p= 0.22), baseline VAS (-7.1 mm, p= 0.11), lumbopelvic reversal (p= 0.06) and positive active hip abduction test (p= 0.06). Significant improvements were seen in standing VAS (-5.6 mm, p< 0.001). The LBP group had beneficial changes in activation strategies in standing flexion (p< 0.05) following intervention, with no changes during frontal plane movement strategies.

CONCLUSIONS

Individuals with LBP meeting clinical prediction rules for stabilization-based exercise demonstrated increased standing tolerance and sagittal plane muscle sequencing following a 6-week intervention.

Differences in Hip Joint Biomechanics and Muscle Activation in Individuals With Femoroacetabular Impingement Compared With Healthy, Asymptomatic Individuals: Is Level-Ground Gait Analysis Enough?

Background:

Femoroacetabular impingement (FAI) is a recognized cause of hip and groin pain and a significant factor in hip joint function during sport. Objective tests for understanding hip function are lacking in this population.

Purpose:

To determine whether biomechanical and electromyographic features of hip function during level-ground walking differ between a group diagnosed with FAI and those with no symptoms of FAI.

Study Design:

Controlled laboratory study.

Methods:

A total of 20 asymptomatic individuals and 20 individuals with FAI walked on a dual-belt instrumented treadmill at self-selected walking velocities. Sagittal and frontal plane joint motions, moments, and muscle activation for the gluteus medius, gluteus maximus, rectus femoris, and medial and lateral hamstrings were analyzed. Discrete measures were extracted from each biomechanical waveform, and principal component analysis was used to determine hip joint muscle activation and hip adduction moment patterns. Statistical significance was determined by use of Student t tests with Bonferroni adjustments for multiple comparisons (α = .05).

Results:

Individuals with FAI walked more slowly (P = .015) and had lower self-reported function (P < .001). No differences in muscle strength were found between the symptomatic and contralateral legs in the FAI group (P > .017), but those with FAI had lower strength in the knee extensors and flexors and the hip extensors, flexors, and adductors compared with the asymptomatic group (P < .017). Individuals with unilateral symptomatic FAI walked with similar biomechanical and hip muscle electromyographic results bilaterally. The only differences found were a greater amplitude of gluteus maximus activation in the FAI symptomatic leg compared with the asymptomatic group and greater medial hamstring activation than lateral hamstring activation in the FAI group in both limbs compared with the asymptomatic group.

Conclusion:

Individuals with FAI were generally deconditioned and reported significantly more functional limitations. No biomechanical differences existed between groups during level walking, yet hamstring and gluteus maximus activation differed when the symptomatic group was compared with the asymptomatic group.

Clinical Relevance:

The field lacks objective testing of hip joint function to understand implications of FAI for dynamic movements, particularly with applications to biomechanics and electromyography. Level walking was of limited value for understanding FAI hip function, and the development of a more challenging gait assessment is warranted.

Hip Abductor Fatigability and Recovery Are Related to the Development of Low Back Pain During Prolonged Standing

A prolonged standing exposure can identify asymptomatic adults who have a higher risk of developing clinical low back pain later in life. Hip abductor cocontraction differences can predict low back pain development during standing exposures. This study’s purpose was to determine if hip abductor strength, fatigability, and recovery during prolonged standing were related to standing-induced low back pain. Forty young, asymptomatic adults (50% female) performed two 2-hour standing sessions; a fatiguing hip abductor exercise was performed prior to 1 of the 2 standing sessions. Hip abductor strength and surface electromyography of gluteus medius and tensor fascia latae were measured. Self-reported low back pain differentiated low back pain developing (PD) and nonpain developing (NPD) groups. The PD group hip abductors fatigued before the NPD group, with similar perceived effort and force losses. Mean power frequency decreases with fatigue were similar between pain groups for all muscles measured after the fatiguing exercise. Unlike NPDs, PDs did not recover force losses after 120 minutes of standing. Hip abductor fatigability may be related to the development of low back pain in this population.

Movement control tests for the lumbopelvic complex. Are these tests reliable and valid?

This study evaluated inter- and intra-observer reliability and discriminative validity of three movement control tests: 1) standing knee-lift test; 2) static lunge test; and 3) dynamic lunge test. Thirty-eight subjects, 21 with low-back pain and 17 healthy, were video-recorded while performing the tests. Four physical therapists scored the tests according to a standardized protocol and calculated a composite score for each test based on the number of incorrect test components. Inter-observer reliability for the composite scores ranged between 0.68 and 0.80 (ICC 2,k) and intra-observer reliability between 0.54 and0.82 (ICC 2,1). The separate test components ranged between 0.32 and 0.91 (κ_free) for inter-observer reliability and 0.42 and1.00 for intra-observer reliability. Test components showing the highest values were: back extension; arm lowering; and shoulders moving backwards. Components hip hitch, trunk lateral flexion, knee not lifted straight up and hips moving backwards did not reach accepted thresholds. Discriminative validity ranged between 0.47 and 0.56 (AUC). As our results showed an overall good agreement for the composite, scores and for the majority of the included test components the tests can be considered reliable enough. As the tests' discriminative ability was close to "none", they should, however, not be used for diagnostic purposes but should be further evaluated toward predicted validity.

Inter-rater Reliability of Sustained Aberrant Movement Patterns as a Clinical Assessment of Muscular Fatigue

BACKGROUND

The assessment of clinical manifestation of muscle fatigue is an effective procedure in establishing therapeutic exercise dose. Few studies have evaluated physical therapist reliability in establishing muscle fatigue through detection of changes in quality of movement patterns in a live setting.

OBJECTIVE

The purpose of this study is to evaluate the inter-rater reliability of physical therapists' ability to detect altered movement patterns due to muscle fatigue.

DESIGN

A reliability study in a live setting with multiple raters.

PARTICIPANTS

Forty-four healthy individuals (ages 19-35) were evaluated by six physical therapists in a live setting.

METHODS

Participants were evaluated by physical therapists for altered movement patterns during resisted shoulder rotation. Each participant completed a total of four tests: right shoulder internal rotation, right shoulder external rotation, left shoulder internal rotation and left shoulder external rotation.

RESULTS

For all tests combined, the inter-rater reliability for a single rater scoring ICC (2,1) was .65 (95%, .60, .71) This corresponds to moderate inter-rater reliability between physical therapists.

LIMITATIONS

The results of this study apply only to healthy participants and therefore cannot be generalized to a symptomatic population.

CONCLUSION

Moderate inter-rater reliability was found between physical therapists in establishing muscle fatigue through the observation of sustained altered movement patterns during dynamic resistive shoulder internal and external rotation.

Multiplanar lumbopelvic control in patients with low back pain: is multiplanar assessment better than single plane assessment in discriminating between patients and healthy controls?

OBJECTIVES

Patients with low back pain (LBP) commonly have lumbopelvic control deficits. Lumbopelvic assessment during sagittal motion is incorporated into commonly used clinical examination algorithms for Treatment Based Classification. The purpose of this study was to investigate whether combined assessment of lumbopelvic control during sagittal and frontal plane motion discriminates between people with and without LBP better than single plane assessment alone.

METHODS

Nineteen patients with LBP and 18 healthy control participants volunteered for this study. The active straight leg raise (ASLR) and active hip abduction (AHAbd) tests were used to assess lumbopelvic control during sagittal and frontal plane motion, respectively. The tests were scored as positive or negative using published scoring criteria. Contingency tables were created for each test alone and for the combined tests (both positive/both negative) with presence/absence of LBP as the reference standard to calculate accuracy statistics of sensitivity (sn), specificity (sp), likelihood (+LR and -LR), and diagnostic odds ratios (OR).

RESULTS

Active straight leg raise and AHAbd tests alone had sn of 0·63, 0·74, respectively, sp of 0·61, 0·50, respectively, and OR of 2·7, 2·8, respectively. The combined tests had sn = 0·89, sp = 0·60, and OR = 12·0. Forty percent of patients with LBP had control deficits in both planes of motion.

DISCUSSION

The AHAbd and ALSR tests appear to have greater diagnostic discrimination when used in combination than when used independently. A percentage of patients with LBP had control deficits in both planes, while others demonstrated uniplanar deficits only. These findings highlight the importance of multiplanar assessment in patients with LBP.

Differences in lumbopelvic control and occupational behaviours in female nurses with and without a recent history of low back pain due to back injury

Low back pain is highly prevalent in nurses. This study aimed to determine which physical fitness, physical activity (PA) and biomechanical characteristics most clearly distinguish between nurses with [recently injured (RInj)] and without [not recently injured (NRInj)] a recent back injury. Twenty-seven (8 RInj, 19 NRInj) female nurses completed questionnaires (pain, work, PA), physical fitness, biomechanical and low back discomfort measures, and wore an accelerometer for one work shift. Relative to NRInj nurses, RInj nurses exhibited reduced lumbopelvic control (41.4% more displayed a moderate loss of frontal plane position), less active occupational behaviours (less moderate PA; less patient lifts performed alone; more sitting and less standing time) and more than two times higher low back discomfort scores. Despite no physical fitness differences, the lumbopelvic control, occupational behaviours and discomfort measures differed between nurses with and without recent back injuries. It is unclear whether poor lumbopelvic control is causal or adaptive in RInj nurses and may require further investigation. Practitioner Summary: It is unclear which personal modifiable factors are most clearly associated with low back pain in nurses. Lumbopelvic control was the only performance-based measure to distinguish between nurses with and without recent back injuries. Future research may investigate whether reduced lumbopelvic control is causal or adaptive in recently injured nurses.

Neuromuscular strategies for lumbopelvic control during frontal and sagittal plane movement challenges differ between people with and without low back pain

Observation-based assessments of movement are a standard component in clinical assessment of patients with non-specific low back pain. While aberrant motion patterns can be detected visually, clinicians are unable to assess underlying neuromuscular strategies during these tests. The purpose of this study was to compare coordination of the trunk and hip muscles during 2 commonly used assessments for lumbopelvic control in people with low back pain (LBP) and matched control subjects. Electromyography was recorded from hip and trunk muscles of 34 participants (17 with LBP) during performance of the Active Hip Abduction (AHAbd) and Active Straight Leg Raise (ASLR) tests. Relative muscle timing was calculated using cross-correlation. Participants with LBP demonstrated a variable strategy, while control subjects used a consistent proximal to distal activation strategy during both frontal and sagittal plane movements. Findings from this study provide insight into underlying neuromuscular control during commonly used assessment tests for patients with LBP that may help to guide targeted intervention approaches.

The interrater reliability of physical examination tests that may predict the outcome or suggest the need for lumbar stabilization exercises

STUDY DESIGN

Interrater reliability.

OBJECTIVES

(1) To examine the interrater reliability of an existing clinical prediction rule (CPR) to predict the success of lumbar stabilization exercises (LSE), and (2) to examine the interrater reliability of 4 clinical tests that may be useful in determining the need for LSE.

BACKGROUND

Physical therapists commonly use LSE to manage patients with low back pain. The clinical efficacy of LSE is unclear. A CPR has been previously suggested to identify patients most likely to benefit from LSE. The passive lumbar extension test, lumbar extension load test, active straight leg raise test, and active hip abduction test are 4 clinical tests that may also suggest the need for LSE. The reliability of these tests has not been established sufficiently.

METHODS

Thirty patients with low back pain, who participated in a larger randomized clinical trial, underwent all tests by 2 independent examiners. Kappa coefficients with 95% confidence intervals (CIs) were calculated to establish the interrater reliability of the CPR and individual tests.

RESULTS

The interrater reliability of the CPR was excellent (κ = 0.86; 95% CI: 0.65, 1.00). The interrater reliability of the individual items making up the CPR, as well as that of the passive lumbar extension test, was substantial (κ = 0.64-0.73 and κ = 0.76, respectively; 95% CI: 0.46, 1.00). The interrater reliability of the active straight leg raise test (κ = 0.53; 95% CI: 0.20, 0.84) and lumbar extension load test (κ = 0.47; 95% CI: 0.14, 0.78) was moderate. The interrater reliability of the active hip abduction test was poor (κ = -0.09; 95% CI; -0.35, 0.27).

CONCLUSION

With the exception of the active hip abduction test, all other clinical tests can be considered sufficiently reliable for clinical use. The relatively small sample size likely contributed to the fairly wide confidence intervals around some of the reliability indices.

Clinical screening tests for assessing movement control in non-specific low-back pain. A systematic review of intra- and inter-observer reliability studies

BACKGROUND

Most people experience back pain at some point during their lives. Reports suggest that core stability interventions in subjects with non-specific low-back pain may increase function, thus decreasing pain. Reliable and validated clinical tests are required for implementing adequate rehabilitation and for evaluating such interventions.

OBJECTIVE

This systematic literature overview seeks to assess the risk of bias and summarise the results of articles assessing the inter-and intra-observer reliability of clinical screening tests for movement control in subjects with non-specific low-back pain.

METHOD

A search was conducted in electronic search engines up until October 2011. The terms 'low-back pain', 'test', 'movement control', 'motor control' and 'physical examination' were defined and used. An appraisal tool (QAREL) was used to assess the risk of bias. Results of the studies were summarised.

RESULTS

Eight studies were included and assessed. All examined inter-observer reliability and three also examined intra-observer reliability. The grading of the studies varied from five to nine positive items out of eleven possible. Inter-observer reliability ranged between poor and very good agreement. Intra-observer reliability ranged between moderate and very good agreement.

CONCLUSION

Most of the tests are presented in studies conducted with a high risk of bias. Their clinical implications can therefore not be suggested. Two tests, prone knee bend and one leg stance are assessed across studies with moderate and good reliability respectively and presented in studies conducted with a lower risk of bias. Their utilisation in clinical work may be recommended.