Inter- and intra-rater-reliability of a clinical framework for spine-related neck-arm pain.

ABSTRACT

OBJECTIVE: A mechanism-based clinical framework for spine-related pain differentiates (i) somatic referred pain, ii) heightened nerve mechanosensitivity, iii) radicular pain, iv) radiculopathy and mixed-pain. This study aimed to determine the reliability of proposed framework. METHOD: Fifty-one people with unilateral spine-related neck-arm pain were assessed and categorized by examiner-1. The classifications were compared to those made by two other examiners, based on written documentation of examiner-1. Cohens kappa was calculated between examiner-pairs; Fleiss Kappa among all examiners to assess agreement in classifying subgroups and entire framework. RESULT: Inter-rater-reliability showed moderate to almost perfect reliability (somatic no variation, mechanosensitivity 0.96 (95% CI 0.87-1.0) to 1.0 (95% CI 1.0-1.0), radicular pain 0.46 (95% CI 0.19-0.69) to 0.62 (95% CI 0.42-0.81), radiculopathy 0.65 (95% CI 0.43-0.84) to 0.80 (95% CI 0.63-0.96) mixed-pain 0.54 (95% CI 0.21-0.81) to 0.75 (95% CI 0.48-0.94). There was almost perfect to moderate reliability among all examiners (somatic no variation, mechanosensitivity 0.97 (95% CI 0.82-1.0), radicular pain 0.56 (95% CI 0.40-0.71), radiculopathy 0.74 (95% CI 0.58-0.90), mixed-pain 0.63 (95% CI 0.47-0.79), entire framework 0.64 (95% CI 0.57-0.71)). Intra-rater-reliability showed substantial to almost perfect reliability (somatic no variation, mechanosensitivity 0.96 (95% CI 0.87-1.0), radicular pain 0.76 (95% CI 0.57-0.92), radiculopathy 0.84 (95% CI 0.67-0.96), mixed-pain 0.83 (95% CI 0.60-1.0), entire framework 0.80 (95% CI 0.61-0.92). CONCLUSION: Moderate to almost perfect reliability in subgrouping people with spine-related neck-arm pain and substantial reliability for entire framework support this classification's reliability.