Background and Purpose. The aim of this study was to examine 5 commonly used questionnaires for assessing disability in people with low back pain. The modified Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire, the Waddell Disability Index, and the physical health scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were compared in patients undergoing physical therapy for low back pain. Subjects and Methods. Patients with low back pain completed the questionnaires during initial consultation with a physical therapist and again 6 weeks later (n=106). Test-retest reliability was examined for a group of 47 subjects who were classified as “unchanged” and a subgroup of 16 subjects who were self-rated as “about the same.” Responsiveness was compared using standardized response means, receiver operating characteristic curves, and the proportions of subjects who changed by at least as much as the minimum detectable change (MDC) (90% confidence interval [CI] of the standard error for repeated measures). Scale width was judged as adequate if no more than 15% of the subjects had initial scores at the upper or lower end of the scale that were insufficient to allow change to be reliably detected. Results. Intraclass correlation coefficients (2,1) calculated to measure reliability for the subjects who were classified as “unchanged” and those who were self-rated as “about the same” were greater than .80 for the Oswestry and Quebec questionnaires and the SF-36 Physical Functioning scale and less than .80 for the Waddell and Roland-Morris questionnaires and the SF-36 Role Limitations–Physical and Bodily Pain scales. None of the scales were more responsive than any other. Discussion and Conclusion. Measurements obtained with the modified Oswestry Disability Questionnaire, the SF-36 Physical Functioning scale, and the Quebec Back Pain Disability Scale were the most reliable and had sufficient width scale to reliably detect improvement or worsening in most subjects. The reliability of measurements obtained with the Waddell Disability Index was moderate, but the scale appeared to be insufficient to recommend it for clinical application. The Roland-Morris Disability Questionnaire and the Role Limitations–Physical and Bodily Pain scales of the SF-36 appeared to lack sufficient reliability and scale width for clinical application.

A Comparison of Five Low Back Disability Questionnaires: Reliability and Responsiveness

Clinical tests of the sacroiliac joint. A systematic methodological review. Part 1: Reliability.

Clinical tests of the sacroiliac joint

Study Design Prospective intertester reliability study investigating the ability of 2 therapists to agree on a low back pain diagnosis using examination techniques and the classification system described by McKenzie. Objectives To investigate intertester agreement in determining McKenzie diagnostic syndromes, subsyndromes, presence, and relevance of the spinal deformities. Background Reliability of the McKenzie approach for determining diagnostic categories is unclear. Previous studies have been characterized by inconsistency of test protocols, criterion measures, and level of training of the examiners, which confounds the interpretation of results. Methods Patients were assessed simultaneously by 2 physical therapists trained in the McKenzie evaluation system. The therapists were randomly assigned as examiner and observer. Agreement was estimated by Kappa statistics. Results Forty-five subjects (47 ± 14 years), composed of 25 women and 20 men with acute, subacute, or chronic low back pain were examined. ...

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Intertester Reliability of the McKenzie Evaluation in Assessing Patients With Mechanical Low Back Pain

Study design Seventy-one patients with low back pain were examined by two physiotherapists (50 patients) and two physicians (21 patients). The two physiotherapists had worked together for many years, but the two physicians had not. The interexaminer reliability of the clinical tests included in the physical examination was evaluated. Objectives To evaluate the interexaminer reliability of clinical tests used in the physical examination of patients with low back pain under ideal circumstances, which was the case for the physiotherapists. Summary of background data Numerous clinical tests are used in the evaluation of patients with low back pain. To reach the correct diagnosis, only tests with an acceptable validity and reliability should be used. Previous studies have mainly shown low reliability. It is important that clinical tests not be rejected because of low reliability caused by differences between examiners in performance of the examination and in their definition of normal results. Methods Two examiners, either two physiotherapists or two physicians, independently examined patients with low back pain. Results In approximately half of the clinical tests studied, an acceptable reliability was demonstrated. Conclusion On the basis of the physiotherapists series, the reliability was acceptable for a number of clinical tests that are used in the evaluation of patients with low back pain. The results suggest that clinical tests should be standardized to a much higher degree than they are today.

Interexaminer reliability in physical examination of patients with low back pain.

The data obtained from the history and examination of patients with low-back pain and sciatica have been subjected to an observer variation analysis. Redesign of the proformata resulted in a reduction of the observer error from 33% to 18% for the history, but no improvement in the finding of a 30% observer error in the examination. The clinician has a simple choice: if he wishes to obtain a large amount of detailed information he must realize that much of it will be unreliable; if he is prepared to limit the information then he will increase its reliability.

de Dombal Ft

Papers

Reliability and reproducibility of clinical findings in low-back pain.