Inter-rater reliability of coupling pattern observations of the pathological lumbar spine: A pilot study

The orthopedic assessment of low back pain by some clinicians is based to some extent, on observational detection of directional lumbar coupling analysis. This assessment process is controversial, specifically in the presence of pathology. The purpose of this study was to investigate the inter-rater reliability among physical therapists when visually determining coupling patterns of the lumbar spine and to examine the relationship between the visual coupling determination and prior attitudinal perceptions of coupling behavior. This pilot study was a single-intervention descriptive study. Twenty physical therapists were asked to record their preconceptions of "standard" lumbar coupling directional patterns. Upon completion, each therapist then assessed the coupling pattern of three patients diagnosed with pathologies of the low back pain. These analyses of L1-2 and L4-5 coupling movements were standardized through the use of videotaping. Each patient actively performed 12 different motions using both sidebending initiation and rotation initiation, in a neutral, flexed, and extended position. The results demonstrated poor observation agreement between physical therapists for sidebending initiation and rotation initiation at segments L1-2 and L4-5 indicating significance greater than chance (p < 0.05). Significant differences between prior coupling perception and the observed findings were established for rotation initiation at segment L4-5. The relationship between prior coupling perception and observation findings was not strong. It appears that physical therapists do not agree on visual coupling assessment but do not rely on preconceptions of coupling behavior to determine coupling direction.

Duke Scholars

Author Chad E. Cook Orthopaedic Surgery, Physical Therapy