Intertester reliability of a low back pain classification system

Spine (Phila Pa 1976). 1999 Feb 1;24(3):248-54. doi: 10.1097/00007632-199902010-00009.


Study design: This prospective study of intertester reliability examined pairs of therapists' ability to agree independently on a patient's low back pain diagnosis.

Objective: To determine the intertester reliability of a low back pain classification system among experienced and novice clinicians.

Background: Many of the disparate categorization schemes for patients with low back pain are purely nominal, assigning designations based on the presumptive source of the problem without providing any practical guide for rehabilitation. A useful classification scheme reliably groups patients into treatment-directing categories.

Methods: The study included 204 patients with low back pain referred to 10 clinics across Canada. Paired physiotherapists performed separate physical examinations on each patient. Both examiners then completed a simple ballot choosing one of five pain patterns.

Results: Agreement on patient classification by independent examiners was 78.9% (kappa = 0.61).

Conclusion: This clinically relevant and clearly defined pain pattern system uses key elements of the history and examination to classify patients with low back pain. The pattern provides a framework for initiating active rehabilitation strategy. Using this approach, clinicians agreed on the categorization of 78.9% of mechanical low back pain cases.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Canada / epidemiology
  • Child
  • Female
  • Humans
  • Low Back Pain* / classification
  • Low Back Pain* / diagnosis
  • Low Back Pain* / epidemiology
  • Male
  • Middle Aged
  • Observer Variation
  • Pain Measurement / standards
  • Pain Measurement / statistics & numerical data
  • Physical Therapy Modalities
  • Prospective Studies
  • Reproducibility of Results
  • Spinal Diseases / diagnosis*
  • Spinal Diseases / epidemiology*