Inter-Tester reliability of discriminatory examination items for sub-classifying non-specific low back pain

Objective: To investigate the inter-tester reliability of a nonspecific low back pain examination procedure, for sub-classifying non-specific low back pain. Design: Reliability study. Participants: Thirty patients with non-specific low back pain (12 males, 18 females, mean age 27.7 years, standard deviation 10.3) and 7 physiotherapists (raters). Methods: Based on a health professionals' consensus via focus groups and a Delphi servey, an examination procedure was developed comprising 206 items discriminatory for nonspecific low back pain, 108 of which were from the History (clinical questions) and 98 from the Physical Examination (clinical tests) section. Utilizing this procedure, each patient was examined by a blinded pair of raters. Results: Moderate to excellent agreement was obtained in 125 (61%) items (77 History and 48 Physical Examination items), 47 of which obtained substantial or excellent agreement (kappa > 0.61), 37 moderate agreement (kappa between 0.41 and 0.6), and 41 excellent percentage agreements. Poor reliability (kappa <0.41) was yielded in the remaining 81 items (31 History and 50 Physical Examination items). Conclusion: Satisfactory reliability was obtained in nearly two-thirds of History and half of the Physical Examination items on a non-specific low back pain assessment list generated through consensus agreement. These findings provide clinicians and researchers with valuable information regarding which items are considered reliable and can be utilized in non-specific low back pain patient evaluation/assessment procedures, classification attempts and clinical trials. © 2012 The Authors.