Based on the upper threshold used ( kappa/ICC > 0.85 ) most procedures demonstrated either conflicting evidence or moderate to strong evidence of low reliability .
When the lower threshold was used ( kappa/ICC > 0.70 ) evidence about pain response to repeated movements changed from contradictory to moderate evidence for high reliability .
Most procedures commonly used by clinicians in the examination of patients with back pain demonstrate low reliability
The purpose of this systematic review was to determine the quality of the research and to assess the reliability of different types of physical examination procedures used in the assessment of patients with non-specific low back pain .
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 , including static and motion palpation and visual observation . 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 st and ardized assessment approach might be helpful in improving the reliability of diagnostic assessment
Based on the upper threshold used ( kappa/ICC > 0.85 ) most procedures demonstrated either conflicting evidence or moderate to strong evidence of low reliability .
When the lower threshold was used ( kappa/ICC > 0.70 ) evidence about pain response to repeated movements changed from contradictory to moderate evidence for high reliability .
Most procedures commonly used by clinicians in the examination of patients with back pain demonstrate low reliability
The purpose of this systematic review was to determine the quality of the research and to assess the reliability of different types of physical examination procedures used in the assessment of patients with non-specific low back pain .