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Evaluation of the Presence of Sacroiliac Joint Region Dysfunction Using a Combination of Tests: A Multicenter Intertester Reliability Study

DL Riddle, PT, PhD, is Associate Professor, Department of Physical Therapy, Medical College of Virginia Campus, Virginia Commonwealth University, 1200 E Broad St, Richmond, VA 23298-0224 (USA) (driddle{at}hsc.vcu.edu).
JK Freburger, PT, PhD, is NRSA Postdoctoral Research Fellow, Cecil G Sheps Center for Health Services Research, and Assistant Professor, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC

Address all correspondence to Dr Riddle

Background and Purpose. The authors examined the intertester reliability of assessments made based on a composite of 4 tests of pelvic symmetry or sacroiliac joint (SIJ) movement that are advocated in the literature for identifying people with SIJ region dysfunction. "Sacroiliac joint region dysfunction" is a term used to describe pain in or around the region of the joint that is presumed to be due to malalignment or abnormal movement of the SIJs. Subjects. Sixty-five patients with low back pain and unilateral buttock pain were seen in 1 of 11 outpatient clinics. Methods. Thirty-four therapists, randomly paired for each subject, served as examiners. Kappa coefficients and observed proportions of positive (P_pos) and negative (P_neg) agreement were calculated to estimate reliability. Results. For the composite test results, percentages of agreement ranged from 60% to 69%, kappa coefficients varied from .11 to .23, and P_pos was lower than 50%. Discussion and Conclusion. Reliability of measurements obtained with the 4 tests appears to be too low for clinical use. Given the measurement error found in this study, the authors suspect it is likely that either the proper treatment technique will not be chosen based on the test results or the intervention will be applied to the wrong side. The 4 tests probably should not be used to examine patients suspected of having SIJ region dysfunction, although the role of therapist training in use of the procedures is unclear.

Key Words: Kappa • Measurement • Reliability • Sacroiliac joint

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