Chiropr Man Therap. 2014 Jun 20;22:22. doi: 10.1186/2045-709X-22-22. eCollection 2014.
Indicating spinal joint mobilisations or manipulations in patients with neck or low-back pain: protocol of an inter-examiner reliability study among manual therapists.
Chiropractic & manual therapies
Emiel van Trijffel, Robert Lindeboom, Patrick Mm Bossuyt, Maarten A Schmitt, Cees Lucas, Bart W Koes, Rob Ab Oostendorp
Affiliations
Affiliations
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands ; Institute for Master Education in Musculoskeletal Therapy, Amersfoort, the Netherlands.
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
- Institute for Master Education in Musculoskeletal Therapy, Amersfoort, the Netherlands.
- Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands ; Department of Rehabilitation, Physiotherapy and Manual Therapy, Faculty of Medicine and Pharmacology, Free University of Brussels, Brussels, Belgium.
PMID: 24982754
PMCID: PMC4074830 DOI: 10.1186/2045-709X-22-22
Abstract
BACKGROUND: Manual spinal joint mobilisations and manipulations are widely used treatments in patients with neck and low-back pain. Inter-examiner reliability of passive intervertebral motion assessment of the cervical and lumbar spine, perceived as important for indicating these interventions, is poor within a univariable approach. The diagnostic process as a whole in daily practice in manual therapy has a multivariable character, however, in which the use and interpretation of passive intervertebral motion assessment depend on earlier results from the diagnostic process. To date, the inter-examiner reliability among manual therapists of a multivariable diagnostic decision-making process in patients with neck or low-back pain is unknown.
METHODS: This study will be conducted as a repeated-measures design in which 14 pairs of manual therapists independently examine a consecutive series of a planned total of 165 patients with neck or low-back pain presenting in primary care physiotherapy. Primary outcome measure is therapists' decision about whether or not manual spinal joint mobilisations or manipulations, or both, are indicated in each patient, alone or as part of a multimodal treatment. Therapists will largely be free to conduct the full diagnostic process based on their formulated examination objectives. For each pair of therapists, 2×2 tables will be constructed and reliability for the dichotomous decision will be expressed using Cohen's kappa. In addition, observed agreement, prevalence of positive decisions, prevalence index, bias index, and specific agreement in positive and negative decisions will be calculated. Univariable logistic regression analysis of concordant decisions will be performed to explore which demographic, professional, or clinical factors contributed to reliability.
DISCUSSION: This study will provide an estimate of the inter-examiner reliability among manual therapists of indicating spinal joint mobilisations or manipulations in patients with neck or low-back pain based on a multivariable diagnostic reasoning and decision-making process, as opposed to reliability of individual tests. As such, it is proposed as an initial step toward the development of an alternative approach to current classification systems and prediction rules for identifying those patients with spinal disorders that may show a better response to manual therapy which can be incorporated in randomised clinical trials. Potential methodological limitations of this study are discussed.
Keywords: Back pain; Clinical reasoning; Decision-making; Diagnostics; Manual therapy; Motion assessment; Neck pain; Reliability
References
- Man Ther. 2009 Apr;14(2):189-96 - PubMed
- Am J Public Health. 2002 Oct;92(10):1634-41 - PubMed
- Phys Ther. 1997 Oct;77(10):1040-51 - PubMed
- Arch Phys Med Rehabil. 2010 Sep;91(9):1313-8 - PubMed
- Med Hypotheses. 2010 Jul;75(1):106-10 - PubMed
- BMJ. 2013 Apr 12;346:f2125 - PubMed
- Open Orthop J. 2013 Sep 20;7:506-20 - PubMed
- J Clin Epidemiol. 1990;43(6):543-9 - PubMed
- Ann Intern Med. 2003 Jun 3;138(11):871-81 - PubMed
- J Clin Epidemiol. 1990;43(6):551-8 - PubMed
- Spine (Phila Pa 1976). 1996 Dec 15;21(24):2820-5 - PubMed
- Phys Ther. 2007 May;87(5):513-24 - PubMed
- Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S14-23 - PubMed
- Aust J Physiother. 2006;52(2):91-102 - PubMed
- Man Ther. 2002 Feb;7(1):19-25 - PubMed
- Torture. 2010;20(2):57-75 - PubMed
- Man Ther. 2005 Nov;10(4):256-69 - PubMed
- CMAJ. 2006 Feb 14;174(4):469-76 - PubMed
- Phys Ther. 1997 Feb;77(2):145-54 - PubMed
- Man Ther. 2002 Feb;7(1):10-8 - PubMed
- Phys Ther. 1998 Jul;78(7):708-37 - PubMed
- Urol Oncol. 2011 Jul-Aug;29(4):462-6 - PubMed
- Spine (Phila Pa 1976). 1996 Dec 15;21(24):2880-4 - PubMed
- J Orthop Sports Phys Ther. 2012 Jan;42(1):5-18 - PubMed
- Phys Ther. 1994 Mar;74(3):219-26 - PubMed
- Man Ther. 2013 Aug;18(4):269-70 - PubMed
- Man Ther. 2007 Feb;12(1):50-5 - PubMed
- Spine (Phila Pa 1976). 2004 May 1;29(9):1022-31 - PubMed
- Pain. 2008 Oct 31;139(3):670-680 - PubMed
- Man Ther. 2006 Nov;11(4):306-15 - PubMed
- Man Ther. 2007 Feb;12(1):72-9 - PubMed
- Spine (Phila Pa 1976). 1998 Jul 1;23(13):1457-63 - PubMed
- Spine (Phila Pa 1976). 2004 Oct 1;29(19):E413-25 - PubMed
- Man Ther. 2009 Jun;14(3):243-51 - PubMed
- J Manipulative Physiol Ther. 2006 Jul-Aug;29(6):475-85, 485.e1-10 - PubMed
- J Clin Epidemiol. 2006 Oct;59(10):1033-9 - PubMed
- Comput Biol Med. 2000 May;30(3):127-34 - PubMed
- BMC Med Res Methodol. 2011 Jun 06;11:87 - PubMed
- Spine (Phila Pa 1976). 2006 Jan 1;31(1):77-82 - PubMed
- Clin Biomech (Bristol, Avon). 2011 Jun;26(5):438-44 - PubMed
- Spine (Phila Pa 1976). 1998 Sep 15;23(18):2014-20 - PubMed
- J Clin Epidemiol. 2000 May;53(5):499-503 - PubMed
- Phys Ther. 2011 Apr;91(4):484-95 - PubMed
- Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S240-52 - PubMed
- Phys Ther. 2003 May;83(5):471-85 - PubMed
- Phys Ther. 2000 May;80(5):499-513 - PubMed
- Arthritis Care Res (Hoboken). 2010 Nov;62(11):1594-601 - PubMed
- BMC Musculoskelet Disord. 2009 Jan 09;10:3 - PubMed
- J Eval Clin Pract. 2013 Dec;19(6):1044-53 - PubMed
- J Orthop Sports Phys Ther. 2012 Jul;42(7):577-92 - PubMed
- Spine (Phila Pa 1976). 1998 Sep 15;23(18):1992-6 - PubMed
- J Manipulative Physiol Ther. 2002 Jan;25(1):42-8 - PubMed
- Phys Ther. 2007 Dec;87(12):1619-32 - PubMed
- Man Ther. 2012 Jun;17(3):201-12 - PubMed
- Arch Phys Med Rehabil. 2005 Sep;86(9):1753-62 - PubMed
- J Manipulative Physiol Ther. 2008 Oct;31(8):616-26 - PubMed
- J Nerv Ment Dis. 1976 Nov;163(5):307-17 - PubMed
- Clin Chem. 2004 Mar;50(3):473-6 - PubMed
- Phys Ther. 2007 Jan;87(1):9-23 - PubMed
- Spine (Phila Pa 1976). 2009 Apr 1;34(7):718-24 - PubMed
- Phys Ther. 2005 Mar;85(3):257-68 - PubMed
- Man Ther. 2013 Jun;18(3):191-8 - PubMed
- Spine (Phila Pa 1976). 2013 Apr 20;38(9):762-9 - PubMed
- J Man Manip Ther. 2009;17(1):36-45 - PubMed
- Aust J Physiother. 1992;38(4):257-60 - PubMed
- Phys Ther. 2011 Apr;91(4):496-509 - PubMed
- Spine (Phila Pa 1976). 2011 Oct 1;36(21 Suppl):S19-42 - PubMed
- Cochrane Database Syst Rev. 2010 Jan 20;(1):CD004249 - PubMed
- Man Ther. 2009 Feb;14(1):36-44 - PubMed
- Phys Ther. 2011 Feb;91(2):165-74 - PubMed
- Man Ther. 2009 Oct;14(5):531-8 - PubMed
- JAMA. 1999 Sep 15;282(11):1061-6 - PubMed
- Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S39-51 - PubMed
- BMC Med Res Methodol. 2010 Jul 03;10:62 - PubMed
- Phys Ther. 1996 Mar;76(3):268-75 - PubMed
- J Clin Epidemiol. 2013 Oct;66(10):1093-104 - PubMed
- Eur Spine J. 2006 Mar;15 Suppl 2:S192-300 - PubMed
- J Manipulative Physiol Ther. 1998 Nov-Dec;21(9):604-10 - PubMed
- Phys Ther. 2004 Feb;84(2):173-90 - PubMed
- Pain. 1999 Apr;80(3):629-636 - PubMed
- Man Ther. 2011 Feb;16(1):3-8 - PubMed
- Pain. 1995 Aug;62(2):233-240 - PubMed
- J Clin Epidemiol. 1993 May;46(5):423-9 - PubMed
- Cochrane Database Syst Rev. 2011 Feb 16;(2):CD008112 - PubMed
- Cochrane Database Syst Rev. 2012 Sep 12;(9):CD008880 - PubMed
- J Electromyogr Kinesiol. 2012 Oct;22(5):655-62 - PubMed
- Ann Intern Med. 2004 Feb 3;140(3):189-202 - PubMed
- Aust J Physiother. 2002;48(3):189-93 - PubMed
- Ann Emerg Med. 1992 Apr;21(4):384-90 - PubMed
- Physiother Can. 2013 Spring;65(2):167-75 - PubMed
- Ann Intern Med. 2004 Dec 21;141(12):920-8 - PubMed
- Spine (Phila Pa 1976). 2005 Jun 15;30(12):1433-40 - PubMed
- Man Ther. 2010 Aug;15(4):315-33 - PubMed
- Man Ther. 2009 Apr;14(2):213-21 - PubMed
- Spine (Phila Pa 1976). 1998 Aug 1;23(15):1689-98 - PubMed
- Phys Ther. 2001 Apr;81(4):1018-28 - PubMed
- Spine (Phila Pa 1976). 2002 Dec 15;27(24):2835-43 - PubMed
- Phys Ther. 1992 Dec;72(12):843-52 - PubMed
- J Manipulative Physiol Ther. 2008 Mar;31(3):172-83 - PubMed
- Aust J Physiother. 1994;40(3):159-65 - PubMed
- Phys Ther. 2005 Nov;85(11):1151-67 - PubMed
- Phys Ther. 2009 Feb;89(2):114-24 - PubMed
- Phys Ther. 2003 May;83(5):455-70 - PubMed
- Biometrics. 1977 Mar;33(1):159-74 - PubMed
- J Orthop Sports Phys Ther. 2011 Feb;41(2):108-17 - PubMed
- Phys Ther. 2010 Jun;90(6):843-54 - PubMed
- J Man Manip Ther. 2010 Jun;18(2):111-8 - PubMed
- Spine (Phila Pa 1976). 2002 Feb 15;27(4):406-11 - PubMed
- Pain Med. 2013 Apr;14(4):460-8 - PubMed
- Phys Ther. 1998 Jan;78(1):33-42 - PubMed
- Physiother Res Int. 1998;3(3):206-27 - PubMed
- BMC Med. 2010 Apr 08;8:22 - PubMed
- Chiropr Osteopat. 2010 Feb 25;18:3 - PubMed
Publication Types