Musanu et al., 2016 Reliability of Physical Examination, Diagnosis and Treatment of Low-Back Pain by Physiotherapy Practitioners in Some Selected Hospitals in Zambia
Background: Low back pain (LBP) is a common disorder that has great consequences in terms of human sufferings and costs related to treatment, disability and lost productivity world over. Reliable physical examination and diagnosis are a fundamental elements in the effective clinical management of LBP. Clinicians like physiotherapists are expected to base their clinical and treatment decisions on physical examination results and diagnosis of LBP. We carried out a study to evaluate the reliability of the physical examination, diagnosis and treatment of LBP by physiotherapy practitioners in five selected referral hospitals in Zambia.
Methodology: A cross sectional study design utilising descriptive correlational techniques were employed for the study. A total of 25 physiotherapy practitioners (n=13 degree and n=12 diploma holders) were recruited for the study. The study included 100 patients aged between 18- 60 years with LBP referred to the physiotherapy department at five referral hospitals across Zambia. A standardized physical examination form was used by raters to capture the required clinical information. The reliability assessments were done using the intrarater and interrater tests. A total of 50 patients were each examined separately and consecutively by two physiotherapy practitioners (interrater) while the remaining 50 patients were examined by single therapists who repeated the examination on the same patient after three days (intrarater). Data was entered using SPSS version and descriptive statistics and Cohen's kappa statistical test was used to assess the level of agreement between the two clinical findings obtained (minimum κ: 0.61).
Results: The interrater and intrarater reliability for the assessment of LBP were; physical examination results (κ: 0.39; fair; range 0.09-0.83) and (κ: 0.62; good; range 0.06-0.94), for diagnosis (κ: 0.65; good; range -0.13-1.00) and (κ: 0.86; very good; range 0.43-1.00) and treatment (κ: 0.66; good; range 0.10-1.00) and (κ: 0.69; good; 0.23-1.00) respectively. Furthermore, the results showed that 14% and 62% of the raters scored above the minimum priori in the interrater and intrarater reliability respectively of physical examination category, while diagnosis had 52% and 92% and treatment had 56% and 60%.
Conclusion: Physical examination techniques among physiotherapy practitioners for LBP varied greatly and had inadequate reliability especially interrater relaibility. The diagnosis and treatment of LBP were considered reliable among physiotherapy practitioners from some selected hospitals in Zambia. A clinically applicable, valid and reliable classification system of physical examination for physiotherapy practitioners may be essential for future high quality research studies to be able to demonstrate the efficacy of diagnosis and physiotherapy
management of LBP in Zambia.