Inter-tester Reliability in Classifying Acute and Subacute Low Back Pain Patients into Clinical Subgroups: A Comparison of Specialists and Non-Specialists. A Pilot Study

Paatelma, Markku; Karvqnen, Eira; Heinqnen, Ari

doi:10.1179/106698109791352166

Cited by 9 publications

(11 citation statements)

References 56 publications

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“…On the other hand, the focus of this study was on this specific classification system, which has been previously demonstrated to be appropriate. 18 In the present study, patients with LBP evaluated by the PTs were in the early phase of their pain, whereas, for prolonged or chronic back pain, it is recommended to use the movement or control impairment classification by Ò Sullivan. 14 Furthermore, the reviewers made their conclusions based solely on records of the data from PTs in this study, but not all of the information that they collected was in their reports (e.g., more information from patients' interviews and negative test results).…”

Section: Discussionmentioning

confidence: 93%

“…We previously demonstrated the sensitivity and specificity of the clinical tests used to distinguish clinically relevant subgroups in the early phase of LBP management. 17,18 Based on these studies, the intraand inter-reliability of the clinical tests used for this study and the clinical test clusters to determine the classification level is good for different testers. 24 The patients' symptoms and onset of the pain mechanism served as the basis for clinical reasoning in the diagnostic decision-making process (Appendix).…”

Section: Methodsmentioning

confidence: 94%

“…13 Subsequent studies have further refined the existing guidelines for classifying patients with NSLBP using more detailed examination criteria. [14][15][16][17][18] However, to date, there is no consensus on which of the LBP classification systems is more accurate or appropriate in the early phase of LBP, and praxis varies. 9,19 Nevertheless, the question arises as to whether or not PTs can learn to apply a specific classification system for patients with non-specific LPB within the context of a continuing education course.…”

Section: Introductionmentioning

confidence: 99%

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Knowledge translation from continuing education to physiotherapy practice in classifying patients with low back pain

Karvonen

Paatelma

Kesonen

et al. 2014

Journal of Manual & Manipulative Therapy

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Objectives: Physical therapists have used continuing education as a method of improving their skills in conducting clinical examination of patients with low back pain (LBP). The purpose of this study was to evaluate how well the pathoanatomical classification of patients in acute or subacute LBP can be learned and applied through a continuing education format. The patients were seen in a direct access setting. Methods: The study was carried out in a large health-care center in Finland. The analysis included a total of 57 patient evaluations generated by six physical therapists on patients with LBP. We analyzed the consistency and level of agreement of the six physiotherapists' (PTs) diagnostic decisions, who participated in a 5-day, intensive continuing education session and also compared those with the diagnostic opinions of two expert physical therapists, who were blind to the original diagnostic decisions. Evaluation of the physical therapists' clinical examination of the patients was conducted by the two experts, in order to determine the accuracy and percentage agreement of the pathoanatomical diagnoses. Results: The percentage of agreement between the experts and PTs was 72-77%. The overall interexaminer reliability (kappa coefficient) for the subgroup classification between the six PTs and two experts was 0.63 [95% confidence interval (CI): 0.47-0.77], indicating good agreement between the PTs and the two experts. The overall inter-examiner reliability between the two experts was 0.63 (0.49-0.77) indicating good level of agreement. Discussion: Our results indicate that PTs' were able to apply their continuing education training to clinical reasoning and make consistently accurate pathoanatomic based diagnostic decisions for patients with LBP. This would suggest that continuing education short-courses provide a reasonable format for knowledge translation (KT) by which physical therapists can learn and apply new information related to the examination and differential diagnosis of patients in acute or subacute LBP.

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Section: Discussionmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Knowledge translation from continuing education to physiotherapy practice in classifying patients with low back pain

Karvonen

Paatelma

Kesonen

et al. 2014

Journal of Manual & Manipulative Therapy

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“…In the OMT group, the participants were clinically assessed and classified into the five patho-anatomical and patho-mechanical subgroups. 13 The group underwent pain treatment, specific mobilization or stabilization, spinal manipulation if indicated, and muscle-stretching techniques. [14][15][16] Typically, between three and five individually selected home exercises were prescribed to actively stabilize or mobilize the lower back, and stretching exercises were to be performed once a day.…”

Section: Pt Omt Groupmentioning

confidence: 99%

Physiotherapy in early phase of low back pain

Paatelma¹

2011

ORR

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Low back pain (LBP) is a substantial health problem and has subsequently attracted a considerable amount of research both in the early and chronic phases. Chronic, nonspecific LBP indicates limited effectiveness from most commonly applied interventions and approaches, but it seems to be opposite in the early phase. Intervention is more effective than advice on staying active in acute LBP, leading to more rapid improvement in function, mood, quality of life, and general health. We compared physiotherapy (PT) that involved 3-7 treatment sessions based on subclassification in early phase LBP (acute and subacute LBP lasting ,3 months) to one session of PT that advised staying active, in 134 LBP patients. Low back and leg pain, disability, and days of sick-leave were evaluated. After 12 months, all groups had only minimal pain and disability. In the advice-only group, those patients who had radiating pain had less improvement compared with other groups, and increasing days of sick-leave because of LBP after 12 months. Compared with the advice-only group, orthopedic manual therapy and McKenzie methods seemed to be slightly more effective than one session of assessment in pain and disability.

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“…And what is the reliability of the tests involved in producing categorization? Paatelma et al (2009) examined Inter-tester reliability in classifying sub-acute low-back-pain patients, comparing specialist and non-specialist examiners. They observed that: "Although a number of LBP classification systems have been proposed, such as a pathoanatomical/pathophysiological classification system, the McKenzie classification, treatment-based classification, and the movement-impairment classification, what is still unclear is which clinical tests between two assessing clinicians are sufficiently reliable to allow subgroup categorization.…”

mentioning

confidence: 99%