Objectives: This study investigated the inter-rater reliability of three structural end-range lumbar segmental instability tests with the highest positive Likelihood Ratio against flexion-extension radiographs, and three functional mid-range clinical tests that predict the success of lumbar stabilization exercises in patients with recurrent or chronic low back pain (R/CLBP). It also investigated the reliability of lumbar segmental instability subclassification as: Functional, Structural and Combined Instability. Method: 40 adult with R/CLBP patients (30 men and 10 women), 18 to 80 years of age, underwent repeated measurements of specific clinical tests for structural or functional lumbar segmental instability. Results: Other than the Lack of Hypomobility with PA Glide test, which was found to be unreliable (percentage agreement = 37.5, and k= - 0.02), all the other tests demonstrated high Kappa coefficients and percentage agreements. The sub-classification categories of lumbar segmental instability (functional, structural, and combined) were found to be significantly reliable (k= 0.722, adjusted k= .7 and k =0.84, respectively). Discussion: All the investigated tests (except lack of hypomobility with PA glide test); as well as, the categories of lumbar segmental instability sub-classification, were significantly reliable in predicting lumbar stabilization. Key words: Low back pain, Segmental instability, Reliability, Physical examination, Clinical prediction rule. Discussion:

LLU Discipline

Physical Therapy


Physical Therapy


School of Allied Health Professions

First Advisor

Lohman III, Everett B.

Second Advisor

Bahjri, Khaled

Third Advisor

Swen, R. Wesley

Degree Name

Doctor of Science (DSc)

Degree Level


Year Degree Awarded

January 2013

Date (Title Page)




Library of Congress/MESH Subject Headings

Joint instability; Low Back Pain - diagnosis; Backache; Lumbar vertebrae;

Subject - Local

Low back pain; Segmental instability; Reliability; Physical examination; Clinical prediction rule; Lumbar



Page Count

69 p.

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses & Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives