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Reliability of visual assessment for lumbar curves in standing: Does clinical experience matter?
Moran, R. W. [24]
Ljubotenski, E. [1]

Journal: International Journal of Osteopathic Medicine Date: 2006/03, 9(1):Pages: 42. doi: Subito , type of study: controlled clinical trial

Full text    (https://www.sciencedirect.com/science/article/pii/S1746068906000228)

Keywords:

clinical experience [6]
inter-rater reliability [11]
intra-rater reliability [6]
lumbar lordosis [2]
controlled clinical trial [283]
visual assessment [2]

Abstract:

Introduction Physical examination of the spine routinely includes visual inspection of spinal posture.1 For osteopaths and other manual and manipulative practitioners the visual assessment of spinal posture is of particular importance since consideration of spinal shape contributes to the diagnostic reasoning process. Despite the widespread acceptance of visual inspection as a routine component of physical assessment there have been very few studies that attempt to measure the reliability of visual inspection of lumbar curves. The aims of this study were to (1) measure inter-rater and intra-rater reliability for the visual assessment of lumbar lordosis of subjects by four groups of observers with different levels of training and clinical experience and (2) determine the influence of clinical experience on reliability of visual assessment. Design A blinded test–retest design was used to examine inter and intra-rater reliability. Methods The study was approved by the Unitec Research Ethics Committee. Participants: Twelve observers (n=12) were recruited from university enrolment records and the Government register of osteopaths using random sampling. Three observers were recruited into each of the following sub-groups: Year 1 of undergraduate study in osteopathy; Year 5 of study in osteopathy; less than 5 years of post-graduate clinical experience in osteopathy; and more than 15 years post-graduate clinical experience in osteopathy. A further 60 subjects (all with musculoskeletal complaints) were recruited via a sample of convenience from patients attending an osteopathy outpatient teaching clinic. A 25s video clip was recorded using digital video of each subject in an upright standing posture. Each video clip consisted of a right lateral view followed by a controlled panning shot to a left lateral view and back again. Subject identity was masked during filming and only the trunk was visible on all video clips. Video clips were arranged in random order on a notebook computer for viewing. To assess intra-rater reliability each video clip was repeated at least twice without knowledge of the observer. Each observer viewed 130 video clips in a single session. All observers viewed the clips in the same order and within a similar timeframe. Observers were instructed to rate the apparent depth of the lumbar lordosis by placing a mark on a 100mm scale with end points labelled “maximum lordosis” and “minimum lordosis” and the midpoint labelled “normal”. Data Analysis: Intraclass correlation coefficients (ICC) and 90% confidence intervals (CI) were calculated for inter-rater and intra-rater measures. Reliability coefficients were interpreted according to the guidelines proposed by Hopkins.2 Results The pooled mean for inter-rater reliability across all sub-groups was r=0.55 (90% CI: 0.33–0.70). Mean reliability coefficients for inter-rater reliability within each group were r=0.47 (90% CI: 0.26–0.63) for Year 1 students; r=0.67 (90% CI: 0.38–0.83) for Year 5 students; r=0.58 (90% CI: 0.41–0.70) for osteopaths with less than 5 years post-graduate clinical experience; r=0.48 (90% CI: 0.28–0.64) for osteopaths with more than 15 years post-graduate clinical experience. The pooled mean for intra-rater reliability across all sub-groups was r=0.71 (90% CI: 0.47–0.86). Mean reliability coefficients for intra-rater reliability within each sub-group was r=0.52 (90% CI: 0.19–0.75) for Year 1 students; r=0.76 (90% CI: 0.53–0.89) for Year 5 students; r=0.81 (90% CI: 0.62–0.91) for osteopaths with less than 5 years post-graduate clinical experience; and r=0.76 (90% CI: 0.53–0.89) for osteopaths with more than 15 years post-graduate clinical experience. Conclusions Inter-examiner reliability was comparable across all sub-groups, however the “Year 5 student” and “5 years of clinical experience” sub-groups outperformed the “Year 1 student” and “15 years clinical experience” sub-groups. Intra-examiner reliability was high across all sub-groups, although Year 1 students were less reliable than observers with more training or clinical experience. The visual assessment of lumbar lordosis as described in this study appears to be reliable.

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