Elsevier

Manual Therapy

Volume 18, Issue 2, April 2013, Pages 103-110
Manual Therapy

Review article
Clinical screening tests for assessing movement control in non-specific low-back pain. A systematic review of intra- and inter-observer reliability studies

https://doi.org/10.1016/j.math.2012.08.004Get rights and content

Abstract

Background

Most people experience back pain at some point during their lives. Reports suggest that core stability interventions in subjects with non-specific low-back pain may increase function, thus decreasing pain. Reliable and validated clinical tests are required for implementing adequate rehabilitation and for evaluating such interventions.

Objective

This systematic literature overview seeks to assess the risk of bias and summarise the results of articles assessing the inter-and intra-observer reliability of clinical screening tests for movement control in subjects with non-specific low-back pain.

Method

A search was conducted in electronic search engines up until October 2011. The terms ‘low-back pain’, ‘test’, ‘movement control’, ‘motor control’ and ‘physical examination’ were defined and used. An appraisal tool (QAREL) was used to assess the risk of bias. Results of the studies were summarised.

Results

Eight studies were included and assessed. All examined inter-observer reliability and three also examined intra-observer reliability. The grading of the studies varied from five to nine positive items out of eleven possible. Inter-observer reliability ranged between poor and very good agreement. Intra-observer reliability ranged between moderate and very good agreement.

Conclusion

Most of the tests are presented in studies conducted with a high risk of bias. Their clinical implications can therefore not be suggested. Two tests, prone knee bend and one leg stance are assessed across studies with moderate and good reliability respectively and presented in studies conducted with a lower risk of bias. Their utilisation in clinical work may be recommended.

Section snippets

Background

Fifty-nine to eighty-four percent of the population exhibit symptoms of back pain at some point during their lives (Walker, 2000). Eighty to ninety percent will recover within six weeks irrespectively of coping strategies or treatment. However, up to 86% of these patients will suffer from recurrence within a year or more (Manchikanti et al., 2009; Stanton et al., 2011).

Up to 90% of low-back pain (LBP) symptoms are classified as non-specific, and the suggested cause is mechanical overuse and

Objective

This study seeks to summarise results and systematically assess the risk of bias in intra- and inter-observer reliability studies evaluating objective and active screening tests for movement control in subjects with non-specific LBP.

Data sources and search strategy

A systematic computerised search was conducted by the author (HC) through the search provider Pubmed and in the Chinal, Amed, Pedro and Swemed+ databases between January and March 2010. A second search was conducted at the end of October 2011. The following limitations were used for Pubmed: males/females, English/Swedish, young adults 19–24, adults 19–44, middle-aged 45–64, age: 65+ years and publication date 1998–2011. An initial search used the key term ‘low-back pain’ to cover a wide range

Results

Relevant articles matching the inclusion criteria were found in Pubmed and Cinahl. One study (Davis et al., 2011) was retrieved through the MeSH terms, ‘Low-back Pain’, and ‘Observer Variation’. In total, the two authors read 34 abstracts and 20 articles. Finally, eight articles met the study objectives as shown in Fig. 1 and are summarised in Table 1. Both authors assessed the risk of bias.

A variety of screening tests were assessed in the included studies and were conducted with various

Discussion

The present study is, to our knowledge, the first systematic review assessing risk of bias and summarising the results of intra- and inter-observer reliability of movement-screening tests in subjects with non-specific low-back pain. The included studies presented a variety of movement screening tests and were conducted with various methods. Only a few tests were assessed across studies and the majority of studies included were conducted with a high risk of bias.

All the included studies (Van

Acknowledgements

The authors wish to thank Tim Crosfield for English proof reading and Björn Äng for valuable advice. This study was financially supported by Minnesfonden with a Master student grant.

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