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 .
Manipulative physiotherapists can reliably palpate nominated lumbar spinal levels.
Palpating a nominated spinal level is a prerequisite to more complex tasks such as palpating the level most likely to be the source of the patient 's symptoms . The aim of this study was to investigate the reliability of physiotherapists with a post-graduate qualification in manipulation ( manipulative physiotherapists )  in palpating the lumbar spines of  patients  in a clinical setting . Three pairs of manipulative physiotherapists palpated the r and omly-nominated lumbar spinal levels of 20 patients presenting to their practice s for treatment of low-back pain . Each therapist marked the skin overlying the spinous process of the nominated spinal level with an ultraviolet pen and these marks were transcribed onto transparencies for analysis . The therapists obtained an overall weighted kappa of 0.92 indicating almost perfect agreement for locating the nominated spinal level . The results of this study indicate that manipulative physiotherapists can reliably palpate nominated lumbar spinal levels , suggesting further training in spinal therapy enhances the palpatory skills of physiotherapists in palpating nominated lumbar spinal levels
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 .