Interexaminer Agreement and Reliability of an Internationally Endorsed Screening Framework for Cervical Vascular Risks Following Manual Therapy and Exercise: The Go4Safe Project.
Rogier F de Best, Michel W Coppieters, Emie van Trijffel and 7 others
PMID 34174073WHAT IT FOUND
When therapists use the IFOMPT framework to screen for cervical vascular risks, they disagree on the three-tier risk score.
However, agreement improves substantially when they simply decide whether to proceed with manual therapy or delay it, suggesting a binary decision is more reliable.
Key findings
01Interexaminer agreement on the original three risk categories (low, intermediate, high) was insufficient, with a weighted kappa of 0.39.
02When high and intermediate risks were combined into a single 'no indication' category, agreement improved to a moderate level with a kappa of 0.60.
03One examiner pair accounted for 50 of the 96 patients, which may have influenced the overall results.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
One examiner pair assessed 50 of the 96 patients, which could skew the results, although a post-hoc analysis without this pair showed similar trends. The study did not compare the therapists' risk assessments against a gold standard diagnostic test, so it measures agreement between therapists, not accuracy. Selection bias is possible because patients at higher risk might have been more willing to participate due to the extra screening. For 23% of patients, the time between tests exceeded one week, and they may have received treatment in the interim, though sensitivity analyses suggested this did not significantly bias the results.
Declared interests
Funded by the Dutch Association for Manual Therapy and supported by the MSG Science Network Physiotherapy. The funders had no role in the design, conduct, or reporting of the study.
The easy way to misread this
Do not interpret the improved reliability in the binary analysis as proof that the framework accurately identifies vascular pathology. The study only shows that therapists agree more when they make a simpler yes/no decision about proceeding with treatment; it does not confirm that their decision is clinically correct or safe.