Review article
Inter- and Intrarater Reliability of Clinical Tests Associated With Functional Lumbar Segmental Instability and Motor Control Impairment in Patients With Low Back Pain: A Systematic Review

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Abstract

Objectives

To provide a comprehensive overview of clinical tests associated with functional lumbar segmental instability and motor control impairment in patients with low back pain (LBP), and to investigate their intrarater reliability, interrater reliability, or both.

Data Sources

A systematic computerized search was conducted on December 1, 2015, in 4 different databases (starting search year is indicated in parentheses, with articles included from that year until December 1, 2015): PubMed (1972–), Web of Science (1955–), Embase (1947–), and MEDLINE (1946–).

Study Selection

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed during design, search, and reporting stages of this review. The included population comprised patients with primary LBP.

Data Extraction

Data were extracted as follows: (1) description and scoring of the clinical tests; (2) population characteristics; (3) inclusion and exclusion criteria; (4) description of the used procedures; (5) results for both intra- and interrater reliability; and eventually (6) notification on used statistical method. The risk of bias of the included articles was assessed with the use of the COnsensus-based Standards for the selection of health Measurement INstruments checklist.

Data Synthesis

A total of 16 records were eligible, and 30 clinical tests were identified. All included studies investigated interrater reliability, and 3 studies investigated intrarater reliability. The identified interrater reliability scores ranged from poor to very good (κ=−.09 to .89; intraclass correlation coefficient, .72–.96), and the intrarater reliability scores ranged from fair to very good (κ=.51–.86).

Conclusions

Three clinical tests (aberrant movement pattern, prone instability test, Beighton Scale) could be identified as having an adequate interrater reliability. No conclusions could be made for intrarater reliability. However, further research should focus on better study designs, provide an overall agreement for uniformity and interpretation of clinical tests, and should implement research regarding validity.

Section snippets

Methods

A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.9

Results

The database search strategy yielded 673 records. After removal of duplicates, 435 records were screened on title and abstract for eligibility, with 55 records going through to the second screening phase. After screening on full text, a total of 1619, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34 records were determined to be eligible (fig 1, table 1). In total, 30 clinical tests were identified, representing a total patient sample of 618 patients (table 2). A detailed description

Discussion

The current review aimed to provide a complete overview of inter- or intrarater reliability or both for clinical tests associated with functional LSI and MCI in patients with LBP. A total of 30 different clinical tests were identified.

Conclusions

Interrater reliability is well investigated, and based on the previously described GRADE method, 3 clinical tests can be concluded to have an adequate interrater reliability: the prone instability test, aberrant movement pattern, and Beighton Scale. The intrarater reliability of the identified clinical tests in the current review is poorly investigated, and no conclusions can be made. Further investigation should focus on better study designs to improve the overall ROB assessment, and more

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    Disclosures: none.

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