154 – THE MULTIDISCIPLINARY INTER-EXAMINER RELIABILITY OF PATIENT SCREENING ASSESSMENTS IN A HOSPITAL-BASED SPINE PROGRAM: A PILOT STUDY

Abstract

Purpose: Screening patients for appropriate treatment is a key component of an effective hospital-based spine service. To date, a standardized and validated method for carrying out this process has not been established. In particular, studies to determine who should staff these screening services, their safety and reliability have not been reported. The goal of this study was to determine the inter-examiner reliability of patient screening assessments by Chiropractors and Spine Physicians.

Method: Prospective observational cohort. 50 consecutive patients with acute lower back pain < 16 weeks duration (QTFSD I, II) referred to a quaternary care hospital spine program were studied. The inter-examiner agreement for 10 physical examination procedures and 5 red flag conditions was calculated using the Cohen’s kappa value. Patients were assessed by one of three spine physicians and one of three Chiropractors for normal or abnormal deep tendon reflexes, nerve root tension signs; lower extremity sensory / motor deficit; muscle atrophy; Schober’s test and depth of lordosis. Any history suggestive of cauda equina, fracture, infection, spinal malignancy or progressive neurological deficit was recorded. The results were compared where applicable, with previously published kappa values for lower back examination procedures.

Results: Four of the 50 patients had one or more red flag conditions with an inter-observer reliability of 0.96; 8 of 10 physical examination procedures had a kappa value of > 0.9; the kappa for + sensory deficit was 0.66 and for + femoral nerve stretch test was 0.47.

Conclusion: In this pilot study, initial patient screening assessments carried out by Chiropractors and Spine Physicians had high inter-observer reliability in 8 of the 10 examination procedures tested and were superior to previously reported multidisciplinary inter-observer kappa values.