تكرار پذيري معاينه باليني در بيماران كمردرد مزمن مشكوك به بي ثباتي سگمنتال مهره هاي كمري

RELIABILITY OF CLINICAL EXAMINATION IN PATIENTS WITH CHRONIC LOW BACK PAIN SUSPECTED TO LUMBAR SEGMENTAL INSTABILITY

BACKGROUND AND OBJECTIVE: Low back pain is one of the most common and costly musculoskeletal pain syndromes, affecting up to %80 of people at some points during their lifetime. Lumbar segmental instability is one of the subgroups of non specific low back pain. Definition of these patients needs high reliable clinical examinations. The aim of this study was to determine the interrater reliability of clinical examination in patients suspected to lumbar segmental instability. METHODS: In this study, fifteen patients with chronic non specific low back pain aged between 18-45 years were selected by non probable sampling method. They were evaluated some clinical examinations include: aberrant movement patterns, VAS (visual analogue scale), flexion and extension range of motion (modified–modified Schubert test), trunk flexor and extensor muscle endurance, side support endurance tests, modified-Oswestry index and prone instability test. Clinical examination was performed in 2 sessions with two days interval. Some statistical tests were used for data analysis contain ICC for relative reliability of quantitative variables, Standard error of measurement for absolute reliability of quantitative variable, KAPPA statistics for qualitative variables and K-S test for normalizing the distribution of variables. FINDINGS: The findings showed a high and very high reliability in modified- Oswestry (ICC=0.95), trunk flexor muscles endurance (ICC=0.91), VAS (ICC=0.92), trunk extensor muscles endurance (ICC=0.85), left side support (ICC=0.7), right side support (ICC=0.77) and flexion range of motion (ICC=0.85) and moderate reliability for extension range of motion (ICC=0.68). KAPPA for aberrant movement patterns (k=0.82) and prone instability test (k=0.85) revealed a high agreement. CONCLUSION: The existence of aberrant movement patterns together with positive prone instability test and chronic recurrent pain accompanying with functional disability are the sign of lumbar segmental instability.