Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain

Objective: To assess the intraexaminer and interexaminer reliability of a multidimensional spinal diagnostic method commonly used by chiropractors.

Design. An intraexaminer and interexaminer Latin square, repeated measures reliability'study. The techniques of diagnosis under investigation included visual postural analysis, pain description by the patient, plain static erect x-ray film of the lumbar spine, leg length discrepancy, neurologic tests, motion palpation, static palpation, and orthopedic tests.

Participants: Three experienced chiropractors examined 19 patients, and 2 experienced chiropractors examined 10 and 9 patients, respectively, who were suffering from chronic mechanical low-back pain.

Results: Intraexaminer reliability of the decision to manipulate a certain spinal segmental level was moderate (κ = 0.47). The interexaminer agreement pooled across all spinal joints indicated fair agreement (κ = 0.27). Interexaminer reliability for individual examiner pairs for the L4/L5 segmental level was slight (κ = 0.09). At the L5/S1 level, the interexaminer reliability was fair (κ = 0.25). For the sacroiliac joints, interexaminer reliability was slight (κ = 0.04 and 0.14).

Conclusion: This study of commonly used chiropractic diagnostic methods in patients with chronic mechanical low-back pain to detect manipulable lesions in the lower thoracic spine, lumbar spine, and the sacroiliac joints has revealed that the measures are not reproducible. The implementation of these examination techniques alone should not be seen by practitioners to provide reliable information concerning where to direct a manipulative procedure in patients with chronic mechanical low-back pain.