Reliability of the MyBack Test Battery in individuals who recovered from low back pain

Background & Aims

Low back pain (LBP) is the most common musculoskeletal condition and the main cause of years lived with disability worldwide (1,2). It is a recurrent condition (3) that can present with motor changes during an episode, and for which physical impairments (PI) can persist in remission of symptoms (4-7). This PI have not been explored in the evaluation or treatment of individuals with this condition or in remission of symptoms (8,9). Physical performance (PP) tests in the areas of musculoskeletal health: cardiorespiratory capacity, motor control, trunk and lower limb resistance strength, and flexibility (10) can be used to assess PI. The literature presents some tests to assess PP in different populations but information on the psychometric properties when applied to individuals who have recovered from LBP is scarce or non-existent (11-34). The aim of this study is to evaluate the intra-rater reliability of a PP battery of tests to assess individuals who have recovered from LBP.

Methods

A test–retest study was conducted with a sample of 22 individuals who have recovered from LBP. The participants performed the PP battery in two different moments, with an interval of 5.27±1.83 days. The assessment consisted in performing the 6-Minute Walk Test, Aberrant Movement Pattern, Prone Instability Test, Trunk Flexor test, Side Bridge (right and left), Biering-Sørensen test, 60-s Sit to Stand, Sit-and-Reach Test, Schober Test in flexion and extension and the Modified Thomas Test. Intraclass Correlation Coefficient (ICC 3,1) and their 95% confidence intervals were calculated. Standard error of measurement and Standard error of measurement %, minimal detectable change and minimal detectable change %, 95% limits of agreement for tests with numerical variables and repeatability coefficient, and Cohen’s k and the percentage of agreement were also estimated for categorical variables (35-39).

Results

For tests whose results correspond to numerical variables, high intra-rater reliability values were obtained (CCI>0.87). Standard error of measurement % values varied between 4.47% for the 6-Minute Walk Test and 19.43% for the Trunk Flexor Test, and minimal detectable change % values varied between 12.38% for 6-Minute Walk Test and 53.87% for the Trunk Flexor Test. Bland & Altman diagrams revealed different ranges for the 95% limits of agreement being less wide for the Schober Test in flexion, and the tests presented high repeatability coefficients. Categorical variables showed high reliability values, with Cohen’s k varying between 0.71 and 1.00 and a showing a high percentage of agreement (>86%).

Conclusions

The results of this study show high intra-rater reliability for the MyBack test battery that aims to assess physical impairments related with cardiorespiratory capacity, motor control, trunk and lower limb resistance strength, and flexibility in individuals who recovered from low back pain, supporting its use both in research contexts and clinical practice. However, some of the tests also demonstrate high measurement error values, which must be considered in clinical practice when choosing a given test to evaluate the effect of a given intervention. Despite this, the results of this study support the use of the MyBack battery to adequately assess physical impairments in individuals who have recovered from low back pain, thus contributing to a greater diversity of assessment tools available in both research and clinical settings.

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