Intraexaminer Reliability of Identifying a Dysfunctional Segment in the Thoracic and Lumbar Spine

doi:10.1016/j.jmpt.2006.01.005

Journal of Manipulative and Physiological Therapeutics

Volume 29, Issue 3, March–April 2006, Pages 203-207

https://doi.org/10.1016/j.jmpt.2006.01.005 Get rights and content

Objective

To examine the intrarater reliability of identifying a manipulable lesion in the lumbar and thoracic spine.

Methods

An experienced osteopath used dynamic and static examination to assess 12 asymptomatic subjects for signs of joint dysfunction in the thoracic and lumbar spine. The selected segment was marked with an UV invisible mark. A second examiner visualized these marks with an UV lamp and recorded them on acetates for analysis; this process was then repeated an hour later. The distance from the marks to a fixed point was measured and within-day intrarater reliability was calculated using intraclass correlation coefficients (ICCs).

Results

The ICC_(1,1) for the thoracic spine was 0.70 (95% confidence interval [CI], 0.27-0.90). In the lumbar spine the ICC_(1,1) was 0.96 (95% CI, 0.87-0.99).

Conclusion

This study shows that the lumbar spine joint perceived to be the joint most likely to benefit from a high-velocity low-amplitude thrust can be identified with good within-day reliability in an asymptomatic sample using a defined examination protocol. However, the reliability in identifying a joint exhibiting signs of segmental dysfunction in the thoracic spine was poor.

Section snippets

Subjects

A convenience sample of 12 asymptomatic (5 male, 7 female) subjects was recruited from the staff and students at a local university. It is often accepted that asymptomatic subjects have nonpainful dysfunctional spinal joints and, thus, subjects were selected from an asymptomatic population as they would have less baseline variability. The subjects all completed a pretest screening questionnaire to ensure they were pain-free and to determine if they had any preexisting medical history that would

Results

The data appeared normally distributed, as confirmed by testing the data using a Kolmogrov-Smirnov test (P > .05). The age of the sample (n = 12, 5 male, 7 female) was 35.7 ± 11.95 years. Body fat might be considered a hindrance to palpation, but the mean of the sample body mass index was 23.9 (range, 18-30), which indicates the sample ranged from underweight to overweight, with none in the obese category, thus limiting the problems associated with excess adipose tissue.

Reliability of

Discussion

These results show that in an asymptomatic sample using a standardized assessment protocol the within-day intrarater reliability for detecting the joint most suitable to receive a spinal manipulation was excellent for clinical measurement in the lumbar spine but moderate to poor in the thoracic spine.¹⁹ The strength of this study is that it tests the clinician's ability to identify the most dysfunctional joint in the area of the spine being examined without need for the joint to be named or

Conclusion

This study shows that a clinically experienced osteopath can identify with good reliability the lumbar spine joint perceived to be the joint most likely to benefit from a high-velocity low-amplitude thrust, in an asymptomatic sample, using a defined examination protocol. However, when using a similarly defined protocol, the same practitioner, not experienced at this particular examination method, had moderate to poor reliability in identifying a joint exhibiting signs of segmental dysfunction

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Citation Excerpt :
The osteopathic profession should explore ways to make these assessments more reliable and examine the validity of landmark asymmetry. Restriction of motion was tested in 4 studies [19,23,28,29] based on spinal or cranial restrictions, equally divided between intra- [23,28] and inter-examiner reliability [19,29]. However, findings could not be compared between the spinal segments and the cranial bones because articular mobility, motion-testing and methodologies are different.
The objective of this systematic review is to identify, evaluate, and synthesize the available evidence concerning studies on diagnostic reliability of osteopathic tests.
A structured literature search was conducted of medical databases Cochrane library, MedLine, EMBASE, CINAHL from 1982 to December 2014.
Inclusion criteria were journal articles on reliability of osteopathic diagnostic palpatory tests. Studies were excluded if the examiners were not osteopaths or if the studies did not examine the reliability of diagnostic methods.
The included studies were appraised by the three authors using an 11-items scale instrument (QAREL) developed to assess the quality of studies of diagnostic reliability. The search strategy identified 159 studies. However, only 17 met the inclusion criteria.
The included studies involved a total of 406 patients (64 symptomatic) and 2 studies used anatomical models. 278 examiners were involved, which included 73 osteopaths and 205 osteopathic students. The body sites studied were divided between those of the pelvis, the lower limbs, the spine, and the cranium. Results of the QAREL checklists indicated that most domains met the criteria for being of high quality.
The quality of the reviewed studies was good, while the levels of diagnostic reliability were heterogeneous. Intra-examiner reliability was higher than inter-examiner reliability. There were no significant differences in respect to evaluated osteopathic clinical diagnostic tests and body sites, either in degrees of palpatory pressure, nor in examiners’ experience. However, proper study designs, consensus training and standardizing procedures, such as the developing of models, could be effective in improving the reliability of palpatory tests.
Assessment of consistency between the arm-fossa test and gillet test: A pilot study
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The purpose of this pilot study was to test methods needed to conduct a study with adequate power to investigate consistency between the arm-fossa test (AFT) and the Gillet test.
A convenience sample of chiropractic college students enrolled in a weekend Sacro-Occipital Technique seminar participated. Each was tested with AFT and sacroiliac orthopedic tests, including the Gillet test. Statistical testing included calculation of κ for consistency of the AFT and Gillet test and their diagnostic efficiency.
This study recruited 14 participants. Important issues arose in gathering and recording data, the standardization of examiner methods, and the flow of participants to examination stations. κ for AFT and Gillet test consistency = 0.55, corresponding to “moderate.”
This pilot suggests that the future study should include a mix of symptomatic and asymptomatic participants; record trichotomous data, where appropriate; use washout periods between diagnostic tests; and refine the selection of orthopedic tests deployed besides the AFT. The preliminary data are consistent with but do not establish due to the very small sample size and experimental design issues, that a positive AFT may be consistent with a negative Gillet test.
The "dog-technique". 1st part: Procedures of diagnosis and treatment
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Depuis quelques années, la littérature se penche sur les vertus de la manipulation vertébrale thoracique dans le traitement des cervicalgies communes. Les auteurs, majoritairement Anglo-Saxons et hispaniques, apportent chacun leur pierre à l’édification de la connaissance commune. La technique du « chien » (dog-technic) et sa variante en position assise sont analysées le plus précisément possible dans la première partie de l’article. La seconde partie est une recherche bibliographique sur les études se prononçant sur son efficacité.
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In recent years, the literature focuses on the effectiveness of the thoracic spinal manipulation in the treatment of common neck pain. The authors, mostly Anglo-Saxon and Hispanic, each bring their stone to the building of common knowledge. The dog-technic and its variant in the sitting position are analyzed as precisely as possible in the first part of the article. The second part is a revue of the studies focusing on its effectiveness.
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Consequently, both Yelland and Christensen question the utility of parts of the thoracic spine examination, because poor reliability of some of the protocol items may hamper the ability of clinicians to diagnose and classify the musculoskeletal component of chest pain (Christensen et al., 2003). Additionally, three more recent studies have evaluated reliability of thoracic spine palpation with mixed results ranging from poor to substantial (Heiderscheit and Boissonnault, 2008; Brismee et al., 2006; Potter et al., 2006); however, these studies use asymptomatic study subjects and the clinical relevance may be questioned. To date, inter-observer reliability of the overall musculoskeletal chest pain diagnosis has never been tested.
Chest pain may be caused by joint and muscle dysfunction of the neck and thorax (termed musculoskeletal chest pain). The objectives of this study were (1) to determine inter-observer reliability of the diagnosis ‘musculoskeletal chest pain’ in patients with acute chest pain of non-cardiac origin using a standardized examination protocol, (2) to determine inter-observer reliability of single components of the protocol, and (3) to determine the effect of observer experience. Eighty patients were recruited from an emergency cardiology department. Patients were eligible if an obvious cardiac or non-cardiac diagnosis could not be established at the cardiology department. Four observers (two chiropractors and two chiropractic students) performed general health and manual examination of the spine and chest wall. Percentage agreement, Cohen's Kappa and ICC were calculated for observer pairs (chiropractors and students) and all. Musculoskeletal chest pain was diagnosed in 45 percent of patients. Inter-observer kappa values were substantial for the chiropractors and overall (0.73 and 0.62, respectively), and moderate for the students (0.47). For single items of the protocol, the overall kappa ranged from 0.01 to 0.59. Provided adequate training of observers, the examination protocol can be used in carefully selected patients in clinical settings and should be included in pre- and post-graduate clinical training.
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The purpose of this study was to evaluate the interexaminer reliability of a leg length analysis protocol between an experienced chiropractor and an inexperienced chiropractic student who has undergone an intensive training program.
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Original ArticleIntraexaminer Reliability of Identifying a Dysfunctional Segment in the Thoracic and Lumbar Spine

Objective

Methods

Results

Conclusion

Section snippets

Subjects

Results

Discussion

Conclusion

J Manipulative Physiol Ther

J Manipulative Physiol Ther

J Manipulative Physiol Ther

Int J Ind Ergon

Man Ther

Man Ther

A comparison of osteopathic spinal manipulation with standard care for patients with low back pain

N Engl J Med

Palpation problems and implications

J Manipulative Physiol Ther

Diagnostic palpation of the spine

J Manipulative Physiol Ther

The reliability of assessment parameters: accuracy and palpation technique

Original Article
Intraexaminer Reliability of Identifying a Dysfunctional Segment in the Thoracic and Lumbar Spine