Inter- and intra-rater reliability of clinical tests associated to functional lumbar segmental instability and motor control impairment in patients with LBP: a systematic review.

OBJECTIVE: To provide a comprehensive overview of clinical tests associated with functional lumbar segmental instability and motor control impairment in patients with low back pain (LBP) and to investigate their intra and/or inter-rater reliability. DATA SOURCES: A systematic computerized search was conducted in four different databases on the 1(st) of December 2015: Pubmed (1972 - ) , Web of Science (1955 - ), Embase (1947 - ), Medline ( 1946 - ). STUDY SELECTION: PRISMA guidelines were followed during design, search and reporting stages of this review. The included population are patients with primary LBP. Data was extracted as follows: (1) description and scoring of the clinical tests (2) population characteristics (3) in- and exclusion criteria (4) description of the used procedures (5) results for both intra- and inter-rater reliability and eventually (6) notification on used statistical method. The risk of bias (ROB) of the included articles was assessed with the use of the COSMIN checklist. DATA SYNTHESIS: A total of 16 records were eligible and 30 clinical tests were identified. All included studies investigated inter-rater reliability and three studies investigated intra-rater reliability. The identified Inter-rater reliability scores ranged from poor to very good (k-0.09-0.89 and ICC 0.72-0.96) and the Intra-rater reliability scores ranged from fair to very good (k 0.51-0.86). CONCLUSIONS: Three clinical tests (aberrant Movement pattern, prone instability test and the beighton scale) could be identified for having an adequate inter-rater reliability. No conclusions could be made for intra-rater reliability. However, further research should focus on better study designs, provide an overall agreement for uniformity and interpretation of clinical tests and should implement research regarding validity.