EDUCATION OF PHYSIOTHERAPISTS IMPROVES INTER-RATER RELIABILITY IN LUMBAR SPINE MOTOR CONTROL TESTS: A RANDOMIZED CONTROLLED TRIAL

D. Riese¹, J. Kool¹, J. Sieben², R.A. de Bie²

¹Kliniken Valens, Valens rehabilitationclinic, Valens, Switzerland, ²Maastricht University, Maastricht, Netherlands

Background: In patients with non-specific low back pain, the movement control tests (MCTs) waiter's bow (WB) and sitting knee extension (SKE) are used to evaluate the ability to actively stabilize the lumbar spine while moving other body parts. However, the effect on reliability of MCTs due to therapist's characteristics and training to improve reliability is unknown.

Purpose: To determine the effect of a one-hour education session, compared with no education, on physiotherapists’ inter-rater reliability in two lumbar spine motor control tests (MCTs): waiter's bow (WB) and sitting knee extension (SKE). To determine whether reliability at baseline and the effect of education are affected by therapist’s clinical experience, knowledge and experience of MCTs, and post-graduate education in manual therapy.

Methods: Design: Randomized controlled trial with blinded measurements.
Participants: Fifty-four physiotherapists from an in- and out-patient rehabilitation center.
Intervention: The experimental group took part in a one-hour group education session, openly rating and discussing video recordings of WB and SKE tests. The control group had no intervention.
Measurements:At baseline and after the experimental group had completed the education session, therapists rated 40 SKE and 40 WB video recordings.
Analysis: Changes in Fleiss' kappa were compared between groups. Differences >0.1 in kappa values were considered meaningful. Regression analysis was used to evaluate the effect of therapist's characteristics on inter-rater reliability at baseline and changes in inter-rater reliability.

Results: The mean age of physiotherapists was 36 years (standard deviation (SD) 12), and professional experience was 0–36 years. Education had a significant and meaningful effect on reliability compared with no education. WB kappa values improved from 0.36 to 0.63 in the experimental group and from 0.39 to 0.46 in the control group. SKE kappa values improved from 0.50 to 0.71 in the experimental group and from 0.49 to 0.57 in the control group. None of the physiotherapists’ characteristics affected reliability at baseline or education effects.

Conclusions: The effect of a one-hour group education session for physiotherapists on inter-rater reliability in MCTs is significant and meaningful. Provision of education for physiotherapists in performing observational tests would improve inter-rater reliability, resulting in improved treatment planning and outcome evaluation.

Implications: Because reliable health measurements are fundamental for clinical diagnosis and outcome measurement, more emphasis should be placed on education to improve reliability in pre- and post-graduate education. The education principles used in this study are widely applicable to improve inter-rater reliability in observational tests.

Funding acknowledgements: This study was conducted as part of a master's degree program. No funding was required.

Keywords:
low back pain
movement control tests
interrater reliability

Topics:
Education
Musculoskeletal

Did this work require ethics approval? No

Reason: Because no clinical intervention was performed in this study and no health-related data were collected, ethics approval is not required.https://swissethics.ch/en/links