Inter-rater reliability of diagnostic criteria for sacroiliac joint-, disc-and facet joint pain

Abstract

BACKGROUND/OBJECTIVE: Several diagnostic criteria sets are described in the literature to identify low back pain subtypes, but very little is known about the inter-rater reliability of these criteria. We conducted a study to determine the reliability of diagnostic tests that point towards SI joint-, disc-or facet joint pain. METHODS: Inter-rater reliability study alongside three randomized clinical trials. Multidisciplinary pain center of general hospital. Patients aged 18 or more with medical history and physical examination suggestive of sacroiliac joint-, disc-and facet joint pain on lumbar level. Making use of nowadays most common used diagnostic criteria, a physical examination is taken independently by three physicians (two pain physicians and one orthopedic surgeon). Inter-rater reliability (Kappa (κ) measure of agreement) and significance (p) between raters are presented. Strengths of agreement, indicated with κ values above 0,20, are presented in order of agreement. RESULTS: One hundred patients were included. None of the parameters from the physical investigation had κ values of more than 0.21 (fair) in all pairs of raters. Between two raters (C and D), there was an almost perfect agreement on three parameters, more specifically ''Abnormal sensory and motor examination, hyperactive or diminished reflexes'', ''Sitting exam shows no reflex, motor or sensory signs in the legs'' and ''Straight leg raising (Laségue) negative between 30 and 70 degrees of flexion''. The ''Drop test positive'' parameters had moderate strength of agreement between raters A and D and fair strength between raters A and B. The ''Digital interspinous pressure test positive'' had moderate strength of agreement between raters C and D and fair strength of agreement between raters A and B as well as raters B and C. Three other parameters had a fair strength of agreement between two raters, all other parameters had a slight or poor strength of agreement. Inter-rater reliability, confidence intervals and significance of pooled items for SI joint-, disc-and facet joint pain are represented; κ values for the pooled parameters of the physical examination suggestive of SI joint pain stayed below 0.20 between all raters. The same applies for the pooled parameters of the physical examination suggestive of facet joint or disc pain. CONCLUSIONS: The poor reliability of the diagnostic parameters seriously limits their predictive validity, and as such their use in patients with low back pain for more than 3 months.