Inter-rater reliability of the dynamic neuromuscular stabilization diaphragm tests among individuals with non-specific low back pain and neck pain

Rajasekar Sannasi; Craig E Morris; Andrew Busch; Thrishala Noronha; Vidhya Krishna P; Martin Stribrny; Alena Kobesova

doi:10.1016/j.msksp.2024.102949

Inter-rater reliability of the dynamic neuromuscular stabilization diaphragm tests among individuals with non-specific low back pain and neck pain

Musculoskelet Sci Pract. 2024 Mar 30:71:102949. doi: 10.1016/j.msksp.2024.102949. Online ahead of print.

Authors

Rajasekar Sannasi¹, Craig E Morris², Andrew Busch³, Thrishala Noronha¹, Vidhya Krishna P¹, Martin Stribrny⁴, Alena Kobesova⁵

Affiliations

¹ Institute of Physiotherapy, Srinivas University, Mangaluru, Karnataka, India.
² Rehabilitation Prague School, Prague, Czech Republic.
³ Department of Health and Human Kinetics, Ohio Wesleyan University, Delaware, OH, United States.
⁴ Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
⁵ Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. Electronic address: alenamudr@me.com.

PMID: 38583363
DOI: 10.1016/j.msksp.2024.102949

Abstract

Background: The Dynamic Neuromuscular Stabilization (DNS) diaphragm test and intra-abdominal pressure regulation test (IAPRT) are qualitative clinical tests that assess postural stability provided by the diaphragm.

Objective: Evaluate the inter-rater reliability of the diaphragm test and IAPRT between an experienced and novice DNS clinician among individuals with non-specific low back pain (LBP) and neck pain.

Methods: Forty-five participants with non-specific LBP and/or neck pain were assessed by an experienced and novice DNS physiotherapist in the diaphragm test and IAPRT, and scored on a visual analog scale (VAS) according to five different criteria.

Results: Moderate reliability was noted when assessing LBP and neck pain patients in the diaphragm test and IAPRT (p < 0.001). Moderate reliability also existed when assessing only LBP (p < 0.001) or neck pain (p = 0.002, p = 0.009) independently. Patients with lower pain (NPRS score of 5 or < ) demonstrated lower intra-class correlation coefficients, yet still moderate reliability in the diaphragm test (p = 0.004) and IAPRT (p = 0.001). Patients with higher pain (NPRS score of 6 or > ) demonstrated greater intra-class correlation coefficients, with the diaphragm test resulting in good reliability (p < 0.001).

Conclusions: The diaphragm test and IAPRT demonstrate moderate reliability between an experienced and novice DNS clinician when evaluating LBP and neck pain patients, with a greater degree of reliability noted in patients suffering from higher reported pain.

Keywords: Back pain; Diaphragm; Inter-rater; Neck pain; Postural stabilization; Postural-respiratory function; Reliability.