COSMIN database

Inter- and Intrarater Reliability of Clinical Tests Associated With Functional Lumbar Segmental Instability and Motor Control Impairment in Patients With Low Back Pain: A Systematic Review

Denteneer, L., Stassijns, G., De Hertogh, W., Truijen, S., and Van Daele, U.
OBJECTIVES: 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 intrarater reliability, interrater reliability, or both.

DATA SOURCES: A systematic computerized search was conducted on December 1, 2015, in 4 different databases (starting search year is indicated in parentheses, with articles included from that year until December 1, 2015): PubMed (1972-), Web of Science (1955-), Embase (1947-), and MEDLINE (1946-).

STUDY SELECTION: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed during design, search, and reporting stages of this review. The included population comprised patients with primary LBP.

DATA EXTRACTION: Data were extracted as follows: (1) description and scoring of the clinical tests; (2) population characteristics; (3) inclusion and exclusion criteria; (4) description of the used procedures; (5) results for both intra- and interrater reliability; and eventually (6) notification on used statistical method. The risk of bias of the included articles was assessed with the use of the COnsensus-based Standards for the selection of health Measurement INstruments checklist.

DATA SYNTHESIS: A total of 16 records were eligible, and 30 clinical tests were identified. All included studies investigated interrater reliability, and 3 studies investigated intrarater reliability. The identified interrater reliability scores ranged from poor to very good (kappa=-.09 to .89; intraclass correlation coefficient, .72-.96), and the intrarater reliability scores ranged from fair to very good (kappa=.51-.86).

CONCLUSIONS: Three clinical tests (aberrant movement pattern, prone instability test, Beighton Scale) could be identified as having an adequate interrater reliability. No conclusions could be made for intrarater 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.
Arch Phys Med Rehabil
Publication year:
Biological and physiological variables:
Biological and physiological variables
Functional status:
Physical functioning
Adults (18-65)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
PRO / non-PRO:
Non-patient Reported Outcome
Type of measurement instrument:
4 - Performance-based tests
6 - Clinical rating scales
Aberrant movements during active ROM
AHAbd - Active Hip Abduction test (also: AHA)
ASLR - Active Straight Leg Raise (versions: Bilateral ASLR)   
Beighton score / Beighton scale   
BKFO - Bent Knee Fall-Out test
Crook lying
Gower sign during active ROM
Hip extension test
Instability Catch during active ROM
JPS - Joint Position Sense (versions: active JPS; passive JPS; various body parts)
LELT - Lumbar Extension Load Test
Multifidus lift test
One-leg standing balance (alias: 1 leg balance; One leg stand; Single leg stance; SLST - Single Leg Stance Test)   
Painful arc during active ROM
Palpation multifidus
Palpation transversus abdominis
Pelvic tilt
PIT - Prone instability test
PLET - Passive Lumbar Extension Test
Posterior shear test
Prone knee bend extension
Prone knee bend rotation
Reversal of lumbopelvic rhythm during active ROM
Rocking backward
Rocking forward
Sagittal deviation during active ROM
SFL - Sitting forward lean test
SKE - Sitting knee extension test
Thoracolumbar dissociation
Waiters bow