Preliminary study of the reliability of assessment procedures for indications for chiropractic adjustments of the lumbar spine

Objective: To assess the intraexaminer and interexaminer reliability of cli nicians trained in flexion-distraction technique to determine the need for chiropractic adjustment of each segment of the lumbar spine. Design: This was an intraexaminer and interexaminer reliability study of co mmonly used chiropractic assessment procedures, Setting: Chiropractic college; by four licensed chiropractors trained in fl exion-distraction technique, two with more than 20 years' experience and tw o with 3 or fewer years' experience. Subjects: Subjects were 18 volunteers; 16 were symptom free, and 2 had low back pain at the time the study was conducted. Main Outcome Measure: The kappa statistic was computed for all comparisons and interpreted in categories ranging from "poor" (<0.00) to "almost perfec t" (>0.80). Results: Intraexaminer reliability was greater than interexaminer reliabili ty. For intraexaminer reliability there was considerable variation by segme nt and among the four examiners, but intraexaminer reliability appeared gen erally higher than interexaminer reliability. Overall, more subluxations we re identified on the second examination than on the first. For interexamine r reliability, kappa scores were generally in the "poor" to "slight" catego ries. Discussion: The results of this study, similar to those of other studies, i ndicate that even chiropractors trained in the same technique seem to show little consensus on the indications for the necessity to adjust specific se gments of the spine. A more standardized assessment approach might be helpf ul in improving the reliability of diagnostic assessments.