Limits...
Inter-examiner reproducibility of tests for lumbar motor control.

Enoch F, Kjaer P, Elkjaer A, Remvig L, Juul-Kristensen B - BMC Musculoskelet Disord (2011)

Bottom Line: These five tests for LMC displayed excellent reproducibility.Also cut-points between subjects with and without LBP must be determined, taking into account age, level of activity, degree of impairment and participation in sports.Whether reproducibility of these tests is as good in daily clinical practice when used by untrained examiners also needs to be examined.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. fe@fysiq.dk

ABSTRACT

Background: Many studies show a relation between reduced lumbar motor control (LMC) and low back pain (LBP). However, test circumstances vary and during test performance, subjects may change position. In other words, the reliability--i.e. reproducibility and validity--of tests for LMC should be based on quantitative data. This has not been considered before. The aim was to analyse the reproducibility of five different quantitative tests for LMC commonly used in daily clinical practice.

Methods: The five tests for LMC were: repositioning (RPS), sitting forward lean (SFL), sitting knee extension (SKE), and bent knee fall out (BKFO), all measured in cm, and leg lowering (LL), measured in mm Hg. A total of 40 subjects (14 males, 26 females) 25 with and 15 without LBP, with a mean age of 46.5 years (SD 14.8), were examined independently and in random order by two examiners on the same day. LBP subjects were recruited from three physiotherapy clinics with a connection to the clinic's gym or back-school. Non-LBP subjects were recruited from the clinic's staff acquaintances, and from patients without LBP.

Results: The means and standard deviations for each of the tests were 0.36 (0.27) cm for RPS, 1.01 (0.62) cm for SFL, 0.40 (0.29) cm for SKE, 1.07 (0.52) cm for BKFO, and 32.9 (7.1) mm Hg for LL. All five tests for LMC had reproducibility with the following ICCs: 0.90 for RPS, 0.96 for SFL, 0.96 for SKE, 0.94 for BKFO, and 0.98 for LL. Bland and Altman plots showed that most of the differences between examiners A and B were less than 0.20 cm.

Conclusion: These five tests for LMC displayed excellent reproducibility. However, the diagnostic accuracy of these tests needs to be addressed in larger cohorts of subjects, establishing values for the normal population. Also cut-points between subjects with and without LBP must be determined, taking into account age, level of activity, degree of impairment and participation in sports. Whether reproducibility of these tests is as good in daily clinical practice when used by untrained examiners also needs to be examined.

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Related in: MedlinePlus

Bland and Altman plots (differences between examiner A and B measures (y-axis), and the mean of examiner A and B (x-axis) for each of the tests), with 95% limits of agreement (LOA) for the five tests (red lines). The green line (y = 0) is perfect average difference, and the purple line is the observed average difference (n = 38 for Sitting Knee Extension, n = 40 for the remaining tests; Leg Lowering in mm Hg, remaining tests in cm). Examiner A and B represent the examiners named A and B. Blue dots represent subjects without Low Back Pain (LBP), while red dots represent subjects with LBP on day of examination.
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Figure 1: Bland and Altman plots (differences between examiner A and B measures (y-axis), and the mean of examiner A and B (x-axis) for each of the tests), with 95% limits of agreement (LOA) for the five tests (red lines). The green line (y = 0) is perfect average difference, and the purple line is the observed average difference (n = 38 for Sitting Knee Extension, n = 40 for the remaining tests; Leg Lowering in mm Hg, remaining tests in cm). Examiner A and B represent the examiners named A and B. Blue dots represent subjects without Low Back Pain (LBP), while red dots represent subjects with LBP on day of examination.

Mentions: For each of the tests, the total mean is reported together with the standard deviation. To evaluate the inter-examiner reproducibility of test performance, intraclass correlation coefficients (ICC) type 2.1 [38,39] and Bland and Altman's [40] limits of agreement (LOA) were used (Figure 1). In order to give clinicians information about the minimal change that is not due to error, the minimal detectable change (MDC) was calculated for each test.


Inter-examiner reproducibility of tests for lumbar motor control.

Enoch F, Kjaer P, Elkjaer A, Remvig L, Juul-Kristensen B - BMC Musculoskelet Disord (2011)

Bland and Altman plots (differences between examiner A and B measures (y-axis), and the mean of examiner A and B (x-axis) for each of the tests), with 95% limits of agreement (LOA) for the five tests (red lines). The green line (y = 0) is perfect average difference, and the purple line is the observed average difference (n = 38 for Sitting Knee Extension, n = 40 for the remaining tests; Leg Lowering in mm Hg, remaining tests in cm). Examiner A and B represent the examiners named A and B. Blue dots represent subjects without Low Back Pain (LBP), while red dots represent subjects with LBP on day of examination.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3116485&req=5

Figure 1: Bland and Altman plots (differences between examiner A and B measures (y-axis), and the mean of examiner A and B (x-axis) for each of the tests), with 95% limits of agreement (LOA) for the five tests (red lines). The green line (y = 0) is perfect average difference, and the purple line is the observed average difference (n = 38 for Sitting Knee Extension, n = 40 for the remaining tests; Leg Lowering in mm Hg, remaining tests in cm). Examiner A and B represent the examiners named A and B. Blue dots represent subjects without Low Back Pain (LBP), while red dots represent subjects with LBP on day of examination.
Mentions: For each of the tests, the total mean is reported together with the standard deviation. To evaluate the inter-examiner reproducibility of test performance, intraclass correlation coefficients (ICC) type 2.1 [38,39] and Bland and Altman's [40] limits of agreement (LOA) were used (Figure 1). In order to give clinicians information about the minimal change that is not due to error, the minimal detectable change (MDC) was calculated for each test.

Bottom Line: These five tests for LMC displayed excellent reproducibility.Also cut-points between subjects with and without LBP must be determined, taking into account age, level of activity, degree of impairment and participation in sports.Whether reproducibility of these tests is as good in daily clinical practice when used by untrained examiners also needs to be examined.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. fe@fysiq.dk

ABSTRACT

Background: Many studies show a relation between reduced lumbar motor control (LMC) and low back pain (LBP). However, test circumstances vary and during test performance, subjects may change position. In other words, the reliability--i.e. reproducibility and validity--of tests for LMC should be based on quantitative data. This has not been considered before. The aim was to analyse the reproducibility of five different quantitative tests for LMC commonly used in daily clinical practice.

Methods: The five tests for LMC were: repositioning (RPS), sitting forward lean (SFL), sitting knee extension (SKE), and bent knee fall out (BKFO), all measured in cm, and leg lowering (LL), measured in mm Hg. A total of 40 subjects (14 males, 26 females) 25 with and 15 without LBP, with a mean age of 46.5 years (SD 14.8), were examined independently and in random order by two examiners on the same day. LBP subjects were recruited from three physiotherapy clinics with a connection to the clinic's gym or back-school. Non-LBP subjects were recruited from the clinic's staff acquaintances, and from patients without LBP.

Results: The means and standard deviations for each of the tests were 0.36 (0.27) cm for RPS, 1.01 (0.62) cm for SFL, 0.40 (0.29) cm for SKE, 1.07 (0.52) cm for BKFO, and 32.9 (7.1) mm Hg for LL. All five tests for LMC had reproducibility with the following ICCs: 0.90 for RPS, 0.96 for SFL, 0.96 for SKE, 0.94 for BKFO, and 0.98 for LL. Bland and Altman plots showed that most of the differences between examiners A and B were less than 0.20 cm.

Conclusion: These five tests for LMC displayed excellent reproducibility. However, the diagnostic accuracy of these tests needs to be addressed in larger cohorts of subjects, establishing values for the normal population. Also cut-points between subjects with and without LBP must be determined, taking into account age, level of activity, degree of impairment and participation in sports. Whether reproducibility of these tests is as good in daily clinical practice when used by untrained examiners also needs to be examined.

Show MeSH
Related in: MedlinePlus