The reliability of selected motion- and pain provocation tests for the sacroiliac joint

The objective of the study was to assess inter-rater reliability of one palpation and six pain provocation tests for pain of sacroiliac origin. The sacroiliac joint (SIJ) is a potential source of low back and pelvic girdle pain. Diagnosis is made primarily by physical examination using palpation and pain provocation tests. Previous studies on the reliability of such tests have reported inconclusive and conflicting results. Fifty-six women and five men aged 18-50 years old were included in the study. Fifteen patients had ankylosing spondylitis; 30 women had post partum pelvic girdle pain for more than 6 weeks; and 16 people had no low back or pelvic girdle pain. All participants were examined twice on the same day by experienced manual therapists. Percentage agreement and kappa statistic were used to evaluate the tests reliability. Results showed percentage agreement and kappa values ranged from 67% to 97% and 0.43 to 0.84 for the pain provocation tests. For the palpation test the percent agreement was 48% and the kappa value was -0.06. Clusters of pain provocation tests were found to have good percentage agreement, and kappa values ranged from 0.51 to 0.75. In conclusion this study has shown the reliability of the pain provocation tests employed were moderate to good, and for the palpation test, reliability was poor. Clusters out of three and five pain provocation tests were found to be reliable. The cluster of tests should now be validated for assessment of diagnostic power.