Poster Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Replication of the intertester reliability of a low back pain classification system. Original CBI Health study: Spine, 24 (3) 1999, pp 248-254 (#145)

Darragh Kenny 1 , Chris Hoffman 1 , Hamilton Hall 2 , Chris Gregg 1
  1. TBI Health, Northland, WELLINGTON, New Zealand
  2. CBI Health, Toronto, Canada

Introduction: 

This prospective study is a replication study of an original 1999 Canadian Back Institute intertester reliability that examined pairs of therapists' ability to agree independently on a patient's low back pain diagnosis.

The objective was to determine the intertester reliability of a low back pain classification system among experienced and novice clinicians, a replication study in a New Zealand population group. The CBI spine classification methodology for low back pain is an assessment and categorising algorithm. It is used to correctly diagnose people into 4 groups, or “patterns”, of back pain to provide for targeted and effective treatment. The aim of researching the assessment and classification system is to provide a further insight into its reliability and accuracy in a patient population.

On review of the literature surrounding the inter tester reliability of a low back pain classification system, there is significant variation in both testing methods and the level of tester agreement, even within the same classification system. Many of the categorisation schemes for patients with reported low back pain are purely nominal, assigning designations based on the presumptive anatomical source of the problem without providing any practical guide for rehabilitation. The original CBI Health 1999 study provided a useful classification scheme to reliably groups patients into subclassifications to assist deliver targeted treatment pathways. Further research was determined to review the replication of the inter-tester-reliability study using the CBI spine classification methodology in categorising Low Back Pain on a separate population group, trained within the same model of care.

Methods: The study included 230 patients with low back and/or leg pain of suspected spinal origin pain referred to 8 TBI Health private practice clinics across New Zealand. Paired physiotherapists performed joint verbal assessments and separate physical examinations on each patient. Both examiners then completed a simple ballot choosing one of six low back pain subclassification ‘pattern’ diagnoses, and an alternative seventh category of an alternative or ‘non-spinal’ diagnosis.

Results: Agreement on patient classification by independent examiners was 81.2% (kappa = 0.65). And additionally, with no statistically significant difference between novice and experienced clinicians.

Discussion This replication study further reinforces the clinical use of a reliable and defined subclassification pain ‘pattern’ system identifying key elements of the clinical history and clinical examination to classify patients with low back pain. The subclassification pattern provides a clinical framework for effective treatment and pathway of care patient management. Using this approach, independent of levels of training and clinical expertise, clinicians agreed on the subclassification categorisation of 81.2% of mechanical low back pain cases in a New Zealand

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