IS THE CLINICAL CONCEPT OF SPINAL STIFFNESS MULTIDIMENSIONAL

Authors
Citation
C. Maher et R. Adams, IS THE CLINICAL CONCEPT OF SPINAL STIFFNESS MULTIDIMENSIONAL, Physical therapy, 75(10), 1995, pp. 854-860
Citations number
34
Categorie Soggetti
Orthopedics,Rehabilitation
Journal title
ISSN journal
00319023
Volume
75
Issue
10
Year of publication
1995
Pages
854 - 860
Database
ISI
SICI code
0031-9023(1995)75:10<854:ITCCOS>2.0.ZU;2-B
Abstract
Background and Purpose. This study investigated whether the poor relia bility of judgments of posteroanterior (PA) spinal stiffness is due to rater bias or is a consequence of raters each having individual conce pts of PA stiffness. Subjects. Three pairs of manipulative physical th erapists with a minimum of 5 years of experience took part in the stud y. Methods. The raters were required to make stiffness judgments of a series of metal springs, and their performance at this task was compar ed with that obtained when they rated the PA stiffness of patients wit h low back pain. A range of reliability indices were calculated and ev aluated to establish whether rater bias contributed to poor reliabilit y in the stimuli and the measured stiffness of the springs was also as sessed using the Pearson Product-Moment Correlation Coefficient. Resul ts. The average intraclass correlation coefficient (2,1) for rating sp ring stiffness was found to be .60, whereas for human spines it was fo und to be .19. There was no evidence of rater bias contributing to poo r reliability for rating stiffness of human spines. The average correl ation between the rater's estimates of the magnitude of the stimuli an d the measured stiffness of the stimuli was .80. Conclusion and Discus sion. Physical therapists demonstrated much better ability to judge sp ring stiffness than the PA stiffness of human spines. This difference in performance implies that mechanical stiffness is not equivalent to the clinical concept and individual interpretation of stiffness as a c onstruct may lead to rater disagreement in the clinic. The reliability of judgements of PA spinal stiffness may be enhanced in the future if its dimensions can be identified, defined, and taken into account dur ing clinical procedures.