Agreeing on clinical tests

I was thinking about why medics and therapists sometimes disagree on a diagnosis. This seems to spark lively debates between practitioners particularly regarding the time honoured lumbar spine V SI joint debate. This started me thinking about the tests we use. Take a look at this research.

Evaluation of the Presence of Sacroiliac Joint Region Dysfunction Using a Combination of Tests: A Multicenter Intertester Reliability Study

Daniel L Riddle, et al

Abstract

Background and Purpose. The authors examined the intertester reliability of assessments made based on a composite of 4 tests of pelvic symmetry or sacroiliac joint (SIJ) movement that are advocated in the literature for identifying people with SIJ region dysfunction. “Sacroiliac joint region dysfunction” is a term used to describe pain in or around the region of the joint that is presumed to be due to malalignment or abnormal movement of the SIJs.

Subjects. Sixty-five patients with low back pain and unilateral buttock pain were seen in 1 of 11 outpatient clinics.

Methods. Thirty-four therapists, randomly paired for each subject, served as examiners.

Results. For the composite test results, percentages of agreement ranged from 60% to 69%, kappa coefficients varied from .11 to .23, and Ppos was lower than 50%.

Discussion and Conclusion. Reliability of measurements obtained with the 4 tests appears to be too low for clinical use. Given the measurement error found in this study, the authors suspect it is likely that either the proper treatment technique will not be chosen based on the test results or the intervention will be applied to the wrong side. The 4 tests probably should not be used to examine patients suspected of having SIJ region dysfunction, although the role of therapist training in use of the procedures is unclear.

It demonstrates some important points. Apply and interpret your tests accurately, any test in isolation is not diagnostic, your colleague may not be wrong – it could be a limitation of the test.

Physical Therapy August 2002 vol. 82 no. 8 772-781

http://ptjournal.apta.org/content/82/8/772.short