Inter- and intra-tester reliability of selected clinical tests in examining patients with early phase lumbar spine and sacroiliac joint pain and dysfunction

Paatelma, Markku; Karvonen, Eira; Heinonen, Ari

doi:10.3109/14038190903582154

Cited by 10 publications

(12 citation statements)

References 41 publications

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“…The performance tests were performed in the following order: Gait pattern : limping, toe-off , heel-strike, step length. Inspection: Scoliosis, lordosis, atrophy of muscles (legs, buttocks and lower back), foot position (e. g. pronation, supination, outfl are and infl are) and leg length diff erence [ 19 ] . After the clinical investigation, information was sent to an orthopedic surgeon who wrote the referral for an MRI/CT investigation.…”

Section: Clinical Investigationmentioning

confidence: 99%

Clinical Examination, Spondylolysis and Adolescent Athletes

Sundell

Jonsson

Ådin³

et al. 2012

Int J Sports Med

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Symptomatic spondylolysis is a stress reaction caused by microtrauma during physical exercise, an imaging diagnostic subgroup of Adolescent Low Back Pain (ALBP), found in adolescent athletes. Early diagnosis increases the possibility of healing. Thus, it is important to divide ALBP into subgroups. The aim of this study was to evaluate clinical tests that can distinguish symptomatic spondylolysis from other forms of ALBP in order to facilitate early referral for diagnostic imaging. The investigation subjects were a prospective case series with a control group, 25 subjects with ALBP and 13 subjects that had no history of LBP. The 2 groups were examined using the same clinical protocol. MRI of the whole lumbar spine was performed in both the case and control groups and CT investigations of the L4 and L5 vertebrae were performed in the case group. Significant differences between the 2 groups were found in 8 of our clinical tests. No clinical test, alone or in combination, could distinguish between spondylolysis and other forms of ALBP. As 88% of the subjects in the case group had MRI findings and almost 50% had spondylolysis, MRI should be performed at an early age in young athletes with ALBP.

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Section: Clinical Investigationmentioning

confidence: 99%

Clinical Examination, Spondylolysis and Adolescent Athletes

Sundell

Jonsson

Ådin³

et al. 2012

Int J Sports Med

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“…Eleven reliability studies [41,57-66] were ranked as being of low quality, fifteen were ranked as moderate quality [33,34,36,37,39,67-76] and five, three of which contained nested reliability studies, were ranked as high quality [54,77-80]. …”

Section: Resultsmentioning

confidence: 99%

Review of methods used by chiropractors to determine the site for applying manipulation

et al. 2013

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BackgroundWith the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation.MethodsStructured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation.ResultsA total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement.ConclusionsA considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.

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“…Three background theories were used when planning the study and when analysing the data: the hypothetico-deductive clinical reasoning model (2), classification of LBP (4,5,19) and King and Kitchener's critical reflection model (9,10). Based on these theories, the coding frames for the data analysis were modified.…”

Section: Discussionmentioning

confidence: 99%

“…In this qualitative study, the most important three background theories and approaches were as follows: (a) the CR approach when examining LBP patients (1-3); (b) classification of LBP in its early phase (4)(5)(6); and (c) the critical reflection process in decision-making and in analysing the physiotherapist's own practice (7)(8)(9)(10). These theories and approaches were used when planning the study and when analysing the data.…”

Section: Introductionmentioning

confidence: 99%