Abstract
Introduction: A large number of patients with non-specific low back pain (NSLBP) are examined by physiotherapists. Physiotherapists ask their patient’s questions, as part of their clinical examination, however the reliability of the information elicited by these questions has never been examined.
Methods: Following a Focus group with a sample of physiotherapists (n=30), and subsequent Delphi technique questionnaire, a list of questions and tests for the clinical examination to NSLBP was developed. The clinical examination list was then tested for item inter-tester reliability with 100 NSLBP patients and 16 physiotherapists. Patients were assessed by both physiotherapists on one day. Data were analysed using kappa coefficients for nominal data and weighted kappas for ordinal data.
Results: The physiotherapists rated issues regarding the location and quality of pain with good levels of reliability, kappa values ranged from 0.49 to 0.64. Diurnal changes in pain and history of pain were also reliably ascertained (Kappa values ranging from 0.49 to 0.73), with symptoms other than pain demonstrating good reliability (values ranging from 0.50 to 0.77). Issues regarding the affect of psychosocial issues as barriers to recovery and the degree to which the patient’s pain was affecting their function were not as reliable (kappa values from 0.14 to 0.51)
Conclusions: It is clear that whilst the questions typically used in the clinical examination of NSLBP are reliable when addressing simple issues relating to the report of symptoms, more complex issues are less reliable and further work is required to improve the reliability of the information obtained.
Correspondence should be addressed to Ms Alison McGregor, c/o BOA, SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
