Clinical screening tests for assessing movement control in low-back pain: a systematic review


Today is the final day of the International Federation of Orthopaedic Manipulative Therapists (IFOMPT) Conference in Quebec, Canada. The conference includes presentations from international experts on a wide array of issues related to clinical assessment and treatment.

In a previous blog I looked at an article on whether or not  individuals’ movement patterns can be altered as a result of treatment. One of the key challenges presented by the authors was that clinicians need to consider carefully how movement patterns can be reliably measured. Therefore, I was really pleased to come across an article that seemed to address this very issue: a systematic review of the reliability of clinical screening tests for assessing movement control in low back pain (LBP) sufferers by Carlsson and Rasmussen-Barr (2012).

Here’s what they did

A systematic search was conducted  in the CINAHL, AMED, Pedro and Swemed+ databases for articles up until the end of October 2011. Articles were evaluated using the Quality Appraisal of Reliability Studies (QAREL) checklist (Lucas et al, 2010), which has 11 items that explore 7 principles covering: the spectrum of subjects, spectrum of examiners, examiner blinding, order effects of examination, suitability of the time interval among repeated measurements, appropriate test application and interpretation, and appropriate statistical analysis. The tests included examined dysfunctional movement control in the trunk and pelvis in subjects with non-specific LBP.

Here’s what they found

After sourcing 1584 papers through the searches that were conducted, only 8 met the inclusion criteria and were included in the review. Nineteen screening tests and one test battery for movement control were assessed for reliability in the eight included studies. All 8 studies examined inter-observer reliability and three also examined intra-observer reliability. However, only 3 of the studies had a low risk of bias according to the QAREL checklist.

The authors concluded

Prone knee bend & single leg stance tests showed most promise

“The results of this literature review indicate that most of the screening tests included, designed for assessing impaired motor control in subjects with LBP, are presented in studies conducted with a high risk of bias. However, two of the tests, prone knee bend and one leg stance are assessed across studies with moderate and good reliability, respectively, and presented in studies conducted a lower risk of bias. Therefore, their utilisation in clinical work may be recommended. However, future research is important to evaluate clinical screening tests in more thorough methodological studies enabling the utilisation of trustworthy screening tests in the clinic.”

The Musculoskeletal Elf’s view

The Musculoskeletal Elf

Movement screening tests are used commonly in the treatment clinic; therefore, it was good to see a review of well known ones in a study that was thoroughly conducted according to the PRISMA statement for reporting systematic reviews. As with many studies the authors emphasise the need for further studies with similar methods in order to be able to generalise the reliability of the test results.

With what movement screening tests are you most familiar? Have you conducted any inter or intra-rater reliability testing in your own clinic? If so, perhaps consider sharing the results with others.

Send us your views on this blog and become part of the ever expanding Musculoskeletal Elf community.


Carlsson, H. & Rasmussen-Barr, E. “Clinical screening tests for assessing movement control in non-specific low-back pain. A systematic review of intra- and inter-observer reliability studies”, Manual Therapy, published online ahead of press, [accessed 4/10/12]

Lucas, N.P., Macaskill, P., Irwig, L., Bogduk, N. (2010) The development of a quality appraisal tool for studies of diagnostic reliability (QAREL) Journal of Clin Epidemiol, 63 (8), pp. 854–861 [pubmed abstract]

QAREL (2012) QAREL checklist and data extraction form [online] [accessed 4/10/12]



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Heather Gray

I am currently the Head of Physiotherapy & Paramedicine at Glasgow Caledonian University and Chair of the Chartered Society of Physiotherapy's Professional Committee. I have worked at the University of Glasgow in several research positions. I am on the Editorial Board of the Journal of Physical Therapy Education. Other work in which I have been involved is as an Educational Consultant with NHS Education for Scotland. Prior to moving into academia I worked in the National Health Service (NHS) in Scotland as a physiotherapist for 11 years.

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