Skip to main content
Top
Published in: European Spine Journal 9/2016

Open Access 01-09-2016 | Original Article

Reliability among clinicians diagnosing low back-related leg pain

Authors: Siobhán Stynes, Kika Konstantinou, Kate M. Dunn, Martyn Lewis, Elaine M. Hay

Published in: European Spine Journal | Issue 9/2016

Login to get access

Abstract

Purpose

To investigate agreement and reliability among clinicians when diagnosing low back-related leg pain (LBLP) in primary care consulters.

Methods

Thirty-six patients were assessed by one of six physiotherapists and diagnosed as having either leg pain due to nerve root involvement (sciatica) or referred leg pain. Assessments were video recorded. In part one, the physiotherapists each viewed videos of six patients they had not assessed. In part two, videos were viewed by another six health professionals. All clinicians made an independent differential diagnosis and rated their confidence with diagnosis (range 50–100 %).

Results

In part one agreement was 72 % with fair inter-rater reliability (K = 0.35, 95 % CI 0.07, 0.63). Results for part two were almost identical (K = 0.34, 95 % CI 0.02, 0.69). Agreement and reliability indices improved as diagnostic confidence increased.

Conclusion

Reliability was fair among clinicians from different backgrounds when diagnosing LBLP but improved substantially with high confidence in clinical diagnosis.
Literature
1.
go back to reference Haswell K, Gilmour J, Moore B (2008) Clinical decision rules for identification of low back pain patients with neurologic involvement in primary care. Spine 33(1):68–73CrossRefPubMed Haswell K, Gilmour J, Moore B (2008) Clinical decision rules for identification of low back pain patients with neurologic involvement in primary care. Spine 33(1):68–73CrossRefPubMed
2.
go back to reference Bogduk N (2009) On the definitions and physiology of back pain, referred pain, and radicular pain. Pain 147(1–3):17–19CrossRefPubMed Bogduk N (2009) On the definitions and physiology of back pain, referred pain, and radicular pain. Pain 147(1–3):17–19CrossRefPubMed
3.
go back to reference Mannion A, Mutter U, Fekete T, Porchet F, Jeszenszky D, Kleinstuck F (2014) Validity of a single-item measure to assess leg or back pain as the predominant symptom in patients with degenerative disorders of the lumbar spine. Eur Spine J 23(4):882–887CrossRefPubMedPubMedCentral Mannion A, Mutter U, Fekete T, Porchet F, Jeszenszky D, Kleinstuck F (2014) Validity of a single-item measure to assess leg or back pain as the predominant symptom in patients with degenerative disorders of the lumbar spine. Eur Spine J 23(4):882–887CrossRefPubMedPubMedCentral
4.
go back to reference Scholz J, Mannion RJ, Hord DE, Griffin RS, Rawal B, Zheng H, Scoffings D, Phillips A, Guo J, Laing RJC, Abdi S, Decosterd I, Woolf CJ (2009) A novel tool for the assessment of pain: validation in low back pain. PLoS Med 6(4):e1000047CrossRefPubMedPubMedCentral Scholz J, Mannion RJ, Hord DE, Griffin RS, Rawal B, Zheng H, Scoffings D, Phillips A, Guo J, Laing RJC, Abdi S, Decosterd I, Woolf CJ (2009) A novel tool for the assessment of pain: validation in low back pain. PLoS Med 6(4):e1000047CrossRefPubMedPubMedCentral
5.
go back to reference Vroomen P, de Krom MC, Knottnerus J (1999) Diagnostic value of history and physical examination in patients with sciatica due to disc herniation; a systematic review. J Neurol 246(10):899–906CrossRefPubMed Vroomen P, de Krom MC, Knottnerus J (1999) Diagnostic value of history and physical examination in patients with sciatica due to disc herniation; a systematic review. J Neurol 246(10):899–906CrossRefPubMed
6.
go back to reference van der Windt DA, Simons E, Riphagen I, Ammendolia C, Verhagen AP, Laslett M, Deville W, Deyo RA, Bouter LM, De Vet HCW, Aertgeerts B (2010) Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev 2(2):CD007431 van der Windt DA, Simons E, Riphagen I, Ammendolia C, Verhagen AP, Laslett M, Deville W, Deyo RA, Bouter LM, De Vet HCW, Aertgeerts B (2010) Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev 2(2):CD007431
7.
go back to reference Jensen M, Brant-Zawadski M, Obuchowski N, Modic M, Malkasian D, Ross J (1994) MRI imaging of the lumbar spine in people without back pain. New Engl J Med 331(2):69–73CrossRefPubMed Jensen M, Brant-Zawadski M, Obuchowski N, Modic M, Malkasian D, Ross J (1994) MRI imaging of the lumbar spine in people without back pain. New Engl J Med 331(2):69–73CrossRefPubMed
9.
go back to reference Karppinen J, Malmivaara A, Tervonen O, Pääkkö E, Kurunlahti M, Syrjälä P, Vasari P, Vanharanta H (2001) Severity of symptoms and signs in relation to Magnetic Resonance Imaging findings among sciatic patients. Spine 26(7):E149–E154CrossRefPubMed Karppinen J, Malmivaara A, Tervonen O, Pääkkö E, Kurunlahti M, Syrjälä P, Vasari P, Vanharanta H (2001) Severity of symptoms and signs in relation to Magnetic Resonance Imaging findings among sciatic patients. Spine 26(7):E149–E154CrossRefPubMed
10.
go back to reference Coggon D, Martyn C, Palmer K, Evanoff B (2005) Assessing case definitions in the absence of a diagnostic gold standard. Int J Epidemiol 34(4):949–952CrossRefPubMed Coggon D, Martyn C, Palmer K, Evanoff B (2005) Assessing case definitions in the absence of a diagnostic gold standard. Int J Epidemiol 34(4):949–952CrossRefPubMed
11.
go back to reference McCarthy CJ, Gittins M, Roberts C, Oldham JA (2007) The reliability of the clinical tests and questions recommended in international guidelines for low back pain. Spine 32(8):921–926CrossRefPubMed McCarthy CJ, Gittins M, Roberts C, Oldham JA (2007) The reliability of the clinical tests and questions recommended in international guidelines for low back pain. Spine 32(8):921–926CrossRefPubMed
12.
go back to reference Smart K, Curley A, Blake C, Staines A, Doody C (2010) The reliability of clinical judgments and criteria associated with mechanisms-based classifications of pain in patients with low back pain disorders: a preliminary reliability study. J Manual Manip Therapy 18(2):102–110CrossRef Smart K, Curley A, Blake C, Staines A, Doody C (2010) The reliability of clinical judgments and criteria associated with mechanisms-based classifications of pain in patients with low back pain disorders: a preliminary reliability study. J Manual Manip Therapy 18(2):102–110CrossRef
13.
go back to reference Vroomen P, de Krom MC, Knottnerus J (2000) Consistency of history taking and physical examination in patients with suspected lumbar nerve root involvement. Spine 25(1):91–96CrossRefPubMed Vroomen P, de Krom MC, Knottnerus J (2000) Consistency of history taking and physical examination in patients with suspected lumbar nerve root involvement. Spine 25(1):91–96CrossRefPubMed
14.
go back to reference Busse J, Riva J, Nash J, Hsu S, Fisher C, Wai E, Brunarski D (2013) Surgeon attitudes toward nonphysician screening of low back or low back-related leg pain patients referred for surgical assessment: a survey of Canadian spine surgeons. Spine 38(7):E402–E408CrossRefPubMed Busse J, Riva J, Nash J, Hsu S, Fisher C, Wai E, Brunarski D (2013) Surgeon attitudes toward nonphysician screening of low back or low back-related leg pain patients referred for surgical assessment: a survey of Canadian spine surgeons. Spine 38(7):E402–E408CrossRefPubMed
15.
go back to reference Kottner J, Audige L, Brorson S, Donner A, Gajewski BJ, Hrobjartsson A, Roberts C, Shoukri M, Streiner DL (2011) Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. J Clin Epidemiol 64(1):96–106CrossRefPubMed Kottner J, Audige L, Brorson S, Donner A, Gajewski BJ, Hrobjartsson A, Roberts C, Shoukri M, Streiner DL (2011) Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. J Clin Epidemiol 64(1):96–106CrossRefPubMed
16.
go back to reference Konstantinou K, Beardmore R, Dunn KM, Lewis M, Hider SL, Sanders T, Jowett S, Somerville S, Stynes S, van der Windt DA, Vogel S, Hay EM (2012) Clinical course, characteristics and prognostic indicators in patients presenting with back and leg pain in primary care, The ATLAS study. BMC Musculoskelet Disord 13:4. doi:10.1186/1471-2474-13-4 CrossRefPubMedPubMedCentral Konstantinou K, Beardmore R, Dunn KM, Lewis M, Hider SL, Sanders T, Jowett S, Somerville S, Stynes S, van der Windt DA, Vogel S, Hay EM (2012) Clinical course, characteristics and prognostic indicators in patients presenting with back and leg pain in primary care, The ATLAS study. BMC Musculoskelet Disord 13:4. doi:10.​1186/​1471-2474-13-4 CrossRefPubMedPubMedCentral
17.
go back to reference Sim J, Wright C (2005) The kappa statistic in reliability studies: use, interpretation and sample size requirements. Phys Ther 85(3):257–268PubMed Sim J, Wright C (2005) The kappa statistic in reliability studies: use, interpretation and sample size requirements. Phys Ther 85(3):257–268PubMed
18.
go back to reference Konstantinou K, Hider S, Vogel S, Beardmore R, Somerville S (2012) Development of an assessment schedule for patients with low back-associated leg pain in primary care: a Delphi consensus study. Eur Spine J 21(7):1241–1249CrossRefPubMed Konstantinou K, Hider S, Vogel S, Beardmore R, Somerville S (2012) Development of an assessment schedule for patients with low back-associated leg pain in primary care: a Delphi consensus study. Eur Spine J 21(7):1241–1249CrossRefPubMed
19.
go back to reference Landis JR, Koch GC (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174CrossRefPubMed Landis JR, Koch GC (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174CrossRefPubMed
20.
go back to reference Dunn KM, Jordan KP, Croft PR (2010) Recall of medication use, self-care activities and pain intensity: a comparison of daily diaries and self-report questionnaires among low back pain patients. Prim Health Care Res Dev 11:93–102CrossRef Dunn KM, Jordan KP, Croft PR (2010) Recall of medication use, self-care activities and pain intensity: a comparison of daily diaries and self-report questionnaires among low back pain patients. Prim Health Care Res Dev 11:93–102CrossRef
21.
go back to reference Patrick DL, Deyo RA, Atlas SJ, Singer DE, Chapin A, Keller RB (1995) Assessing health-related quality of life in patients with sciatica. Spine 20(17):1899–1908CrossRefPubMed Patrick DL, Deyo RA, Atlas SJ, Singer DE, Chapin A, Keller RB (1995) Assessing health-related quality of life in patients with sciatica. Spine 20(17):1899–1908CrossRefPubMed
22.
go back to reference Schafer A, Hall TM, Ludtke K, Mallwitz J, Briffa N (2009) Interrater reliability of a new classification system for patients with neural low back-related leg pain. The Journal of Manual and Manipulative Therapy 17(2):109–117CrossRefPubMedPubMedCentral Schafer A, Hall TM, Ludtke K, Mallwitz J, Briffa N (2009) Interrater reliability of a new classification system for patients with neural low back-related leg pain. The Journal of Manual and Manipulative Therapy 17(2):109–117CrossRefPubMedPubMedCentral
23.
24.
go back to reference Vach W (2005) The dependence of Cohen’s kappa on the prevalence does not matter. J Clin Epidemiol 58(7):655–661CrossRefPubMed Vach W (2005) The dependence of Cohen’s kappa on the prevalence does not matter. J Clin Epidemiol 58(7):655–661CrossRefPubMed
25.
go back to reference Freynhagen R, Rolke R, Baron R, Tolle TR, Rutjes A-K, Schu S, Treede R-D (2008) Pseudoradicular and radicular low-back pain—a disease continuum rather than different entities? Answers from quantitative sensory testing. Pain 135(1–2):65–74CrossRefPubMed Freynhagen R, Rolke R, Baron R, Tolle TR, Rutjes A-K, Schu S, Treede R-D (2008) Pseudoradicular and radicular low-back pain—a disease continuum rather than different entities? Answers from quantitative sensory testing. Pain 135(1–2):65–74CrossRefPubMed
26.
go back to reference Lin C, Verwoerd A, Maher C, Verhagen A, Pinto R, Luijsterburg P, Hancock M (2014) How is radiating leg pain defined in randomized controlled trials of conservative treatments in primary care? A systematic review. Eur J Pain 18(4):455–464CrossRefPubMed Lin C, Verwoerd A, Maher C, Verhagen A, Pinto R, Luijsterburg P, Hancock M (2014) How is radiating leg pain defined in randomized controlled trials of conservative treatments in primary care? A systematic review. Eur J Pain 18(4):455–464CrossRefPubMed
27.
go back to reference Coleman T (2000) Using video-recorded consultations for research in primary care: advantages and limitations. Fam Pract 17(5):422–427CrossRefPubMed Coleman T (2000) Using video-recorded consultations for research in primary care: advantages and limitations. Fam Pract 17(5):422–427CrossRefPubMed
Metadata
Title
Reliability among clinicians diagnosing low back-related leg pain
Authors
Siobhán Stynes
Kika Konstantinou
Kate M. Dunn
Martyn Lewis
Elaine M. Hay
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 9/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-015-4359-2

Other articles of this Issue 9/2016

European Spine Journal 9/2016 Go to the issue