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Table 5 Summary of the articles on reliability

From: A literature review of clinical tests for lumbar instability in low back pain: validity and applicability in clinical practice

Article Clinical test and scores Inclusion (I) and exclusion (E) criteria Population Reliability Rater/s
Hicks et al. [23] - Painful arc in flexion I: current complaints of LBP. N 63 Inter-rater reliability. N. 4
- Painful arc on return E: symptoms referred below the knee, LBP which may be attributed to current pregnancy, fractures in acute phase, tumor, infection, previous lumbar surgical fusion. 20-66 yrs For each pair of raters, the first rater performs all clinical examination measures on each subject; the second rater, who is blinded to the results of the first evaluation, then performs the same examination procedures, after a minimum of 15- minutes. PT1: PT and chiropractor with 3 yrs of experience as a chiropractor and 2 yrs as an OMT
- Instability catch   - Age 36.0 ± 10.3   PT2: PT with 6 yrs of experience in orthopedic setting
- Gower sign (“thigh climbing”)   - Gender: 38♀, 25♂   PT3: OMT with 8 yrs of experience
- Reversal of lumbopelvic rhythm   - Previous LBP episodes, 51/63.   PT4: PT with 4 yrs of experience on orthopedic environment.
- Aberrant Movement Pattern: positive if at least one of the five previously cited signs is present.     3 pair of raters: PT1 + PT2, PT2 + PT3, PT1 + PT4
- Prone Instability Test: Positive test: pain provoked during the first part of the test disappears when the test is repeated with the legs off the floor.
Fritz et al. [24] - Aberrant Movement Pattern: Painful arc on flexion; Painful arc on return; Instability catch; Gower sign (“thigh climbing”); Reverse lumbopelvic rhythm. Positive test when at least 1 of the previous 5 signs was present. I: complaint of LBP with or without radiation into the lower extremities, < 60 yrs N. 38 patients taken by a sample of 49 patients with these characteristics: Inter-rater reliability. N. 2 physical therapists
- Prone Instability Test: Positive test when pain provoked during the first part of the test decreases when the test is repeated with the legs off the floor. E: contraindications to radiographic assessment (e.g., current pregnancy), previous lumbar fusion surgery, inability (e.g. pain or muscle spasm) to actively flex and extend the spine adequately to permit an assessment of segmental motion. - Age: 39.2 ± 11.3 yrs; The second rater repeats the assessment 5 minutes after the first rater’s assessment  
- Posterior Shear Test: Positive test if familiar symptoms are provoked.   - Duration of symptoms (median days) 78;   
- Distribution of symptoms: back/buttock only 63.3%, symptoms distal to the knee 30.6%;
- Previous history of LBP: 83.7%
- LBP episodes becoming more frequent: 30.6%
Schneider et al. [27] - Prone instability test: Positive test when pain provoked during the first part of the test disappears when the test is repeated with the legs off the floor. I: History of LBP, age between 18 and 65 years, ability to tolerate lying prone N. 39 volunteer patients with history of LBP and undergoing chiropractic treatment at the time of their enrollment in the study Inter-rater reliability. N. 2 experienced doctors of chiropractic (25 and 10 years of clinical experience, respectively).
  E: History of prior lumbar surgery, stenosis, scoliosis greater than 20°, unstable spondylolisthesis, positive nerve root tension or radiculopathy, any red flags suggestive of spinal pathology.    
Ravenna et al. [26] - Prone Instability Test with additional guidelines: I: chronic or recurrent LBP; age 18 to 60 years; current symptoms of LBP, but not acute phase. - N. 30 Inter-rater reliability for PIT examined under 2 conditions: N. 2 examiners:
→ A trunk stabilizing belt is placed around the subject and the table at shoulder level, E: BMI > 30 kg/m2, disk herniation, symptoms referred below the knee, lower extremity weakness or loss of reflexes, history of spinal surgery or fracture, spinal deformity, systemic inflammatory condition, neurologic disease or other serious medical conditions. LBP attributable to pregnancy or a primary hip problem. - Age 36.1 ± 11.8 yrs PIT test with additional guidelines Second-year physical therapy student
→ A stool may be placed under the subject’s feet if the feet do not comfortably reach the floor.   - Men: 56.7% PIT test without additional guidelines. Licensed physical therapist with 2 years of clinical experience in outpatient orthopedic physical therapy
   - Diagnosis: degenerative disk disease 16.6%, disk problem 10%, LBP 73.4%   
- Previous LBP episodes: 83.0%
- Current VAS (0–10): 2.8 ± 1.6
Positive and negative criteria:     
Positive level if the subject reports a decrease of pain with the second P/A, lifting the legs in the second part of the test
Negative test if the subject reports superficial bone-on-bone pressure;
Negative test if the subject reports an increase in symptoms lifting the legs during the second part of the test;
Negative level if the subject reports an increase or same with the second P/A, compared with the first.
Rabin et al. [12] - Aberrant Movement Pattern. Painful arc on flexion; Painful arc on return; Instability catch; Gower sign (“thigh climbing”); Reverse lumbopelvic rhythm. Positive test when at least one of the cited five signs is present. I: age between 18 and 60 years, main complaint of LBP and/or related leg symptoms (i.e., pain, paresthesia) N. 30 consecutive patients with LBP of any duration, with or without associated leg symptoms. Interrater reliability N. 4 raters physical therapists, with experience ranging from 13 to 25 yrs.
- Prone Instability Test: Positive when pain elicited during the first part of the test is relieved or abolished during the second part. E: pregnancy; history suggesting a non-mechanical origin of symptoms (e.g., malignancy, inflammatory conditions), LBP due to a fracture, osteoporosis, regular use of corticosteroids, rheumatoid arthritis, presence of 2 or more signs suggesting lumbar nerve root compression. - Age: 33.5 ± 8.0 yrs AMP was assessed by the two raters simultaneously; PIT and PLE are assessed by the two raters separately (second assessment 5 minutes after the first one). One rater with postprofessional master’s degree (contributes to rating all subjects).
- Passive Lumbar Extension Test: Positive if LBP is elicited.   - Gender: 15♀, 15♂   Other raters with bachelor degree in physical therapy contribute to rating in 23, 4, and 3 subjects, respectively.
   - Duration of symptoms: 164.4 ± 321.8 days   
- Previous LBP episodes: 20 subjects