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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Online ISSN 1973-9095
Ergonomics Unit, Rehabilitation Center of Montescano, “S. Maugeri” Foundation, IRCCS and Center for the Study of Motor Activities, Medical Center of Pavia, “S. Maugeri” Foundation, IRCCS, Pavia, Italy
The aim of this paper was to review the literature concerning reliability of strength and endurance tests to discuss the clinical applicability of such tests or the eventual need for new tests and study designs for the low back and abdominal muscles considering strength and endurance. The literature search for this paper was made in Medline Pubmed (1972-1999) with the following key-words: “low-back pain, functional capacity, strength, endurance, trunk muscles”. We included all studies concerning strength or endurance test for the trunk or abdominal muscles in relation to reliability. We excluded all the studies measuring reliability with less than 30-min interval or less than 1-min pause between maximal isometric contractions. Exclusion criteria were also: number of subjects < 20, no information on distribution of measurements (mean, standard deviation, range of test and retest) provided, no adequate information on study design, poor statistics (i.e. Pearson r, ICCC without any further information). We have reviewed the literature concerning the intra- and inter-observer reliability of the following tests used for low-back disorders: maximal voluntary contraction in standing and seated position, isometric leg/squat and back lift, endurance, static endurance in abdominal muscles, dynamic endurance of back extensors, dynamic endurance of abdominals, dynamic isokinetic strength measurements, repetitive movements. So far, most of the cited reliability tests did not show definitive results. In clinical studies patients are often used as subjects and the degree of biological variation of distress may indeed have an effect on reliability. In general, inter-observer reliability is slightly lower than intra-observer reliability. Inconsistencies in the instructions to the subjects could partly account for this difference. The need of proper familiarization has been shown in several studies and for almost every measure. An actual correlation between trunk strength or endurance and occurrence of LBP has not been clearly shown.
Whether lack of reliability can explain the fact that no true predictors of LBP has been found is debatable. For strength measurements this is probably not the case: reliability is in fact fair, but no predictive indications have been found in large prospective studies. On the other hand, endurance as measured by the Sørensen test has shown some predictive value, but reliability was more fluctuating. Recommendations for future research must therefore address the development of new endurance tests with higher reliability.