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Nässelqvist P.1, Sandén S.1, Röijezon U.1
1Luleå University of Technology, Health Sciences, Luleå, Sweden
Background: Non-specific low back pain (NSLBP) is a major worldwide health problem associated with high levels of disability. NSLPB display morphological changes, disturbed sensory and neuromuscular functioning, and altered motor control strategies. Abundant research and clinical approaches have during the last decades been directed towards alterations in motor control, and assessments and interventions targeting sensorimotor functions using stable or unstable surfaces or systems to reduce pain and disability. Reliable and validated clinical tests to identify neuromuscular dysfunctions in NSLBP are scarce, but of great importance to tailor and improve physiotherapy interventions. A specific method, Neurac, uses slings to introduce instability to assess and train motor control. Up to date no study has, to our knowledge, investigated the inter-rater reliability of Neurac´s lumbar test protocol.
Purpose: Investigate the inter-rater reliability of Neurac´s lumbar test protocol and associations between test performance and LBP.
Methods: A cross-sectional inter-rater reliability design was used. Forty-eight participants completed the tests, twenty-nine with low back pain (LBP) (mean age 47,5, SD ± 11,8) and nineteen without LBP (mean age 40,8, SD ± 10,8). Thirty-nine were female and nine men. Two experienced physiotherapists (PTs) evaluated Neurac´s lumbar test protocol comprising of five myofascial chain tests performed for left and right side, respectively, i.e., altogether ten tests. The two PTs independently rated the performance of the tests at the same time in a standardized manner on a three-point dichotomous scale, higher scores indicating better performance. An overall agreement period, to obtain 80 % agreement, was done prior to testing. Pain was measured with VAS. Inter-rater reliability for the separate tests scores and the total test score, respectively, was determined using Cohen´s Kappa (k), Confidence interval (95 % CI) and percentage of agreement. Independent t-test and correlation analysis was used to investigate associations between test scores and pain.
Results: The kappa value for the ten myofascial chain tests ranged from 0.69 -1.0. Five tests of ten demonstrated a substantial reliability, k ranged between 0,69 0,80. The other five tests demonstrated an excellent to perfect reliability, k ranged between 0,84 1,0. The total Neurac lumbar test protocol, incorporating all ten tests, demonstrated an excellent agreement, k = 0.83. The 95% CI for k were above 0.4 for all tests. There was no significant difference in total sum score between the LBP and non-LBP groups. Within the LBP group there was a significant negative correlation between total test score and pain intensity
(r -0.46, p=0.01).
Conclusion(s): Neurac´s lumbar test protocol appears to be reliable in detecting neuromuscular dysfunction/impaired motor control in patients with and without LBP, when the assessment was performed by two experienced PT. Validity of the test protocol was supported by the fact that increased pain was associated with decreased performance within the LBP group.
Implications: The results have implications for the usability of the test protocol as a clinically reliable and valid assessment tool to identify motor control disturbance in LBP. The test can be used to guide tailored physiotherapeutic exercise interventions to reduce symptoms and improve functions and abilities.
Funding acknowledgements: None
Topic: Musculoskeletal: spine
Ethics approval: The study was approved by the ethics committee of the Department of Health Sciences at Luleå University of Technology.
All authors, affiliations and abstracts have been published as submitted.
