The inter-rater and intra-rater reliability of passive physiological accessory movement assessment of lumbar spine in novice manual therapists.

Passive Physiological Accessory Movements (PPAVMs) are commonly used assessment and treatment techniques in patients with low back pain. Many physiotherapists, including novices, consider PPAVMs an important tool for assessment and treatment of low back pain. Reliability is important as a judgement on the reproducibility of assessment procedures between therapists. However, the reliability of PPAVMs seems to have some problems, and reliability of PPAVMs has not yet been established amongst novice manual therapists. This study aimed at investigating inter-rater and intra-rater reliability of PPAVMs in novice physiotherapists. Fifty two healthy participants were recruited for the study. PPAVMs were applied by two novice physiotherapists and accessory movements were assessed, and both the raters were blinded from each others' findings to avoid bias. The mobility was graded on a three point scale with grade 1 being considered as hypomobile, 2 as normal and 3 as hypermobile. This procedure was performed on all five lumbar segments. Each participant was assessed on the same day for inter-rater reliability, and for intra-rater reliability the participant was assessed by one rater a week later. Kappa (κ) was calculated for all the levels of lumbar spine which ranged between 0.01 and 0.30 for inter-rater reliability and 0.24 to 0.57 for intra-rater reliability. Percentage exact agreement was also computed which showed a range between 38.4% and 57.6%. The values of 'κ' showed poor intra-rater and inter-rater reliability. However, further research is advisable in order to assess the role of experience in reproducibility of PPAVMs.