Development of a clinical examination in non specific low back pain: a Delphi technique

OBJECTIVE: To establish the discriminatory items of the clinical examination of non-specific low back pain, important to physiotherapists. DESIGN: A focus group and Delphi technique with UK physiotherapists. SUBJECTS: A purposive sample of 30 physiotherapists attended a focus group and completed 3 rounds of Delphi questionnaires. METHODS: Data were analysed using mixed qualitative and quantitative approaches. A frequency content analysis identified commonly identified tests and questions, whilst the Delphi consensus technique assumed consensus had been reached with greater than 80% agreement on item inclusion or exclusion. RESULTS: The focus group established the structure of the clinical examination with 15 domains of questioning or physical testing. Three rounds of Delphi questionnaires established the important items of the clinical examination. The list of tests and questions included items evaluating both the psychosocial and biomedical status of the patient as well as questions screening for red flags. CONCLUSION: This is the first work to establish discriminatory tests in the clinical examination of non-specific low back pain, important to physiotherapists. The clinical examination will subsequently be evaluated for item validity and data will undergo cluster analysis. The items of this clinical examination may provide evidence for the existence of homogenous sub-groups within the heterogeneous non-specific low back pain diagnosis.