The Interrater Reliability Among Physical Therapists Newly Trained in a Classification System for Acute Low Back Pain

Abstract

Study Design: A prospective methodological interrater reliability study. Objectives: To calculate the interrater reliability among clinicians newly trained in a classification system for acute low back pain and to determine the level of agreement at key junctures within the classification algorithm. Background: The utility of a classification system for patients with low back pain depends on its reliability and generalizability. To be practical, clinicians must be able to apply the system after a reasonable amount of training. Identifying key points in the classification algorithm where disagreement occurs can lead to better operational definitions. Methods: Four physical therapists read an article and attended a 1-day training session in the classification system. Randomly paired therapists classified patients referred for treatment of acute low back pain and noted decisions at key junctures in the system algorithm. Results: Forty-five patients were classified. Repeated examinations did not increase the patient's pain (P Ͼ.05). For 3 out of the 4 therapists, the interrater reliability showed a kappa value of 0.45. The fourth therapist, excluded from the overall analysis, exhibited a bias towards the immobilization classification. Among the 3 therapists, major disagreement occurred with the determination of symmetry with trunk side bending and the effects of repeated movements. Conclusions: Three out of 4 clinicians newly trained in the system showed moderate reliability. The reliability was slight when the fourth therapist was included. Refinement of the operational definitions and criteria for determining lumbar capsular patterns are needed. One day of training is probably not adequate for all therapists, especially for those biased towards specific low back pain syndromes.

The cost-effectiveness of a treatment-based classification system for low back pain: design of a randomised controlled trial and economic evaluation

“…Kiesel et al [22] achieved a slightly higher kappa value (0.65) with 8 PTs who were familiar with the classification system and 30 patients with LBP. Heiss et al [23], in a study in which 45 acute LBP patients were classified by four PTs who were unfamiliar with the classification system, found a low kappa value (0.15). Finally, Fritz et al [24] investigated the inter-rater reliability of the system in a vignette study with 30 PTs and 123 LBP patients, and reported a kappa value of 0.60.…”

Reliability of novice raters in using the movement system impairment approach to classify people with low back pain

“…Furthermore, the use of paper cases removes additional confounding factors such as exam performance by the clinician that can influence reliability outcomes and thus allows the examination of the classification algorithm itself. Other studies, in contrast, have actually had raters examine patients repeatedly (Wilson et al, 1999; Heiss et al, 2004; Petersen et al, 2004; Fritz et al, 2006; Trudelle-Jackson et al, 2008; Harris-Hayes and Van Dillen, 2009; Vibe Fersum et al, 2009). The same patients are examined by different clinicians to determine if similar clinical results are obtained and if assignment to a particular classification category by different examiners is the same for each patient.…”