Preliminary study of the reliability of assessment procedures for indications for chiropractic adjustments of the lumbar spine

Objective: To assess the intraexaminer and interexaminer reliability of clinicians trained in flexion-distraction technique to determine the need for chiropractic adjustment of each segment of the lumbar spine. Design: This was an intraexaminer and interexaminer reliability study of commonly used chiropractic assessment procedures, Setting: Chiropractic college; by four licensed chiropractors trained in flexion-distraction technique, two with more than 20 years' experience and two with 3 or fewer years' experience. Subjects: Subjects were 18 volunteers; 16 were symptom free, and 2 had low back pain at the time the study was conducted. Main Outcome Measure: The kappa statistic was computed for all comparisons and interpreted in categories ranging from "poor" (<0.00) to "almost perfect" (>0.80). Results: Intraexaminer reliability was greater than interexaminer reliability. For intraexaminer reliability there was considerable variation by segment and among the four examiners, but intraexaminer reliability appeared generally higher than interexaminer reliability. Overall, more subluxations were identified on the second examination than on the first. For interexaminer reliability, kappa scores were generally in the "poor" to "slight" categories. Discussion: The results of this study, similar to those of other studies, indicate that even chiropractors trained in the same technique seem to show little consensus on the indications for the necessity to adjust specific segments of the spine. A more standardized assessment approach might be helpful in improving the reliability of diagnostic assessments.