1
|
Scogin WM, Sanford D, Greenway MB, Ledbetter M, Washmuth NB. The influence of body painting on L4 spinous process palpation accuracy in novice palpators. J Man Manip Ther 2023:1-6. [PMID: 37930272 DOI: 10.1080/10669817.2023.2278264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES Current literature remains inconclusive regarding the best methodology to accurately palpate lumbar spinous processes (SP). Body painting (BP) uses markers to draw anatomical structures on the skin's surface. While BP can be a useful tool for engaging learners, it is unknown whether it improves palpation accuracy. The purpose of this study was to investigate whether the addition of body painting to palpation education improves lumbar spinous process palpation accuracy in first-year Doctor of Physical Therapy (DPT) students. METHODS Thirty-eight DPT students were randomized into a traditional palpation group and a body painting (BP) group. Each group received identical instruction on palpating the lumbar spine, with the BP group additionally drawing lumbar SPs on their laboratory partner with a marker. Students were then assessed on their ability to accurately palpate the L4 SP on randomly assigned subjects. Two Certified Registered Nurse Anesthetists (CRNAs) used ultrasound imaging to confirm the location of each student's palpation. Palpation time was also recorded. The BP group also completed a survey on the learning experience. RESULTS Forty-five percent of students were able to accurately palpate the L4 SP. There was no significant difference (p = 0.78) in palpation accuracy between the traditional and BP group, although students in the BP group were randomly assigned subjects with a significantly (p = 0.005) higher BMI. Ninety-five percent of students were able to palpate within one spinal level of the L4 SP. Students in the BP group reported that the BP activity facilitated learning and active participation. There was no significant difference in palpation time (p = 0.98) between groups. There was a fair correlation (r=-0.41) between palpation accuracy and subject BMI. DISCUSSION/CONCLUSION While body painting was an enjoyable activity to incorporate into palpation laboratory, it is unclear whether it enhanced lumbar SP palpation accuracy in first-year DPT students.
Collapse
Affiliation(s)
- William M Scogin
- Department of Physical Therapy, Samford University, Birmingham, AL, USA
| | - David Sanford
- Department of Physical Therapy, Samford University, Birmingham, AL, USA
| | | | - Maria Ledbetter
- Department of Physical Therapy, Samford University, Birmingham, AL, USA
| | | |
Collapse
|
2
|
Monfrini R, Rossetto G, Scalona E, Galli M, Cimolin V, Lopomo NF. Technological Solutions for Human Movement Analysis in Obese Subjects: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23063175. [PMID: 36991886 PMCID: PMC10059733 DOI: 10.3390/s23063175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 05/27/2023]
Abstract
Obesity has a critical impact on musculoskeletal systems, and excessive weight directly affects the ability of subjects to realize movements. It is important to monitor the activities of obese subjects, their functional limitations, and the overall risks related to specific motor tasks. From this perspective, this systematic review identified and summarized the main technologies specifically used to acquire and quantify movements in scientific studies involving obese subjects. The search for articles was carried out on electronic databases, i.e., PubMed, Scopus, and Web of Science. We included observational studies performed on adult obese subjects whenever reporting quantitative information concerning their movement. The articles must have been written in English, published after 2010, and concerned subjects who were primarily diagnosed with obesity, thus excluding confounding diseases. Marker-based optoelectronic stereophotogrammetric systems resulted to be the most adopted solution for movement analysis focused on obesity; indeed, wearable technologies based on magneto-inertial measurement units (MIMUs) were recently adopted for analyzing obese subjects. Further, these systems are usually integrated with force platforms, so as to have information about the ground reaction forces. However, few studies specifically reported the reliability and limitations of these approaches due to soft tissue artifacts and crosstalk, which turned out to be the most relevant problems to deal with in this context. In this perspective, in spite of their inherent limitations, medical imaging techniques-such as Magnetic Resonance Imaging (MRI) and biplane radiography-should be used to improve the accuracy of biomechanical evaluations in obese people, and to systematically validate less-invasive approaches.
Collapse
Affiliation(s)
- Riccardo Monfrini
- Dipartimento di Ingegneria dell’Informazione, Università degli Studi di Brescia, 25123 Brescia, BS, Italy
| | - Gianluca Rossetto
- Dipartimento di Ingegneria dell’Informazione, Università degli Studi di Brescia, 25123 Brescia, BS, Italy
| | - Emilia Scalona
- Dipartimento di Specialità Medico-Chururgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, 25123 Brescia, BS, Italy
| | - Manuela Galli
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, MI, Italy
| | - Veronica Cimolin
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, MI, Italy
- Istituto Auxologico Italiano, IRCCS, S. Giuseppe Hospital, Piancavallo, 28824 Oggebbio, VB, Italy
| | - Nicola Francesco Lopomo
- Dipartimento di Ingegneria dell’Informazione, Università degli Studi di Brescia, 25123 Brescia, BS, Italy
| |
Collapse
|
3
|
Smeltz AM, Commander CW, Arora H. Pro: Fluoroscopic Guidance Should Be Routinely Used to Place Cerebrospinal Fluid Drains for Patients Undergoing Aortic Surgery. J Cardiothorac Vasc Anesth 2023; 37:179-182. [PMID: 36273944 DOI: 10.1053/j.jvca.2022.09.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/24/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Alan M Smeltz
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Clayton W Commander
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Harendra Arora
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
| |
Collapse
|
4
|
Subramanian S, Reshma BM, Salim Iqbal M, Harsoor SS. A comprehensive, bed-side scoring system to predict difficult lumbar puncture. J Anaesthesiol Clin Pharmacol 2023; 39:38-44. [PMID: 37250250 PMCID: PMC10220197 DOI: 10.4103/joacp.joacp_77_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/07/2021] [Accepted: 05/20/2021] [Indexed: 03/21/2023] Open
Abstract
Background and Aims Spinal anesthesia (SA) is the most widely practiced neuraxial anesthesia. Lumbar puncture (LP) at multiple levels and multiple attempts due to any reason may cause discomfort and even serious complications. Hence the study was conducted to evaluate the patient variables that can predict difficult LP thus allowing for the use of alternate techniques. Material and Methods We included 200 patients of ASA physical status I-II, scheduled to undergo elective infra-umbilical surgical procedures under spinal anesthesia. During preanesthetic evaluation, difficulty score was assessed using the 5 variables: Age, abdominal circumference, spinal deformity - assessed as axial trunk rotation (ATR) value, anatomical spine assessed by spinous process landmark grading system (SLGS) and patient position, by assigning a score of 0- 3 for each variable, with a total score of 0 - 15. The difficulty of LP was graded as easy, moderate or difficult based on total number of attempts and spinal levels by independent experienced investigator. The scores obtained during preanesthetic evaluation and the data collected after performing LP were analyzed using multivariate analysis and P value noted. Results Our study showed that above patient variables correlated well with difficult LP scoring (P < 0.001). SLGS was noted to be a strong predictor, while ATR value a weak predictor. The correlation between the total score and grades of SA had a positive association (R = 0.6832, P < 0.00001) and was statistically significant. A median difficulty score of 2, 5 and 8 predicted easy, moderate and difficult LP respectively. Conclusion The scoring system provides for a useful tool to predict difficult LP and helps both patient and anesthesiologist to choose an alternative technique.
Collapse
Affiliation(s)
- Shobha Subramanian
- Department of Anesthesiology, Dr. B. R. Ambedkar Medical College and Hospital, Gandhi Nagar, Kadugondanahalli, Bengaluru, Karnataka, India
| | - BM Reshma
- Department of Anesthesiology, Dr. B. R. Ambedkar Medical College and Hospital, Gandhi Nagar, Kadugondanahalli, Bengaluru, Karnataka, India
| | - M. Salim Iqbal
- Department of Anesthesiology, Dr. B. R. Ambedkar Medical College and Hospital, Gandhi Nagar, Kadugondanahalli, Bengaluru, Karnataka, India
| | - SS Harsoor
- Department of Anesthesiology, Dr. B. R. Ambedkar Medical College and Hospital, Gandhi Nagar, Kadugondanahalli, Bengaluru, Karnataka, India
| |
Collapse
|
5
|
Mackey S, Howarth SJ, Frey M, De Carvalho D. An investigation of the flexion relaxation ratio in adults with and without a history of self-reported low back pain and transient sitting-induced pain. J Electromyogr Kinesiol 2022; 67:102719. [PMID: 36334404 DOI: 10.1016/j.jelekin.2022.102719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
It is unknown whether the presence of sitting-induced pain or a clinical history of low back pain (LBP) changes spine function outcomes such as the flexion relaxation ratio (FRR). The purpose of this investigation was to determine whether sitting-induced pain or a history of non-specific LBP results in a different FRR. Forty-seven participants were instrumented with surface electromyography over erector spinae at L1, and accelerometers at L1 and S2. Standing maximum lumbar flexion trials were taken preceding and following a 1-hour sitting trial. Pain ratings during sitting and history of LBP were used to group participants for analysis. FRR values taken after the sitting exposures were compared between those that did and did not develop pain during sitting. Baseline FRR values were compared participants with and without a history of LBP. No significant differences in FRR were found for either pain groups (p = 0.11) or clinical history (p = 0.85). Lack of differences may be due to participants not currently experiencing a clinical episode of pain when the ratio was measured and/or because 1-hour sitting exposure was not long enough to induce pain modulation. The findings suggest that neither sitting-induced pain development or clinical history need to be controlled to prevent confounding of FRR.
Collapse
Affiliation(s)
- Sarah Mackey
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Samuel J Howarth
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Mona Frey
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Diana De Carvalho
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
| |
Collapse
|
6
|
Huang P, Zheng B, Liu S, Xu L, Chen C, Zhan S. Effectiveness of Ultrasound Imaging in Assessing the Palpation Skills of Rotating Physicians. Front Genet 2022; 13:894716. [PMID: 35754796 PMCID: PMC9217061 DOI: 10.3389/fgene.2022.894716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/13/2022] [Indexed: 12/04/2022] Open
Abstract
As an important means of physical examination, palpation is usually limited to the physical examination before surgery and used as an auxiliary method for disease diagnosis in the field of surgery. In practice, palpation is also used in every aspect of the surgical procedure, and its application is of great significance to surgery. The purpose of this study was to investigate the ability of ultrasound imaging to assess the ability of rotating physicians to locate musculoskeletal structures by palpation. Rotating physicians were asked to palpate and locate the long head tendon of the biceps (LHB), posterior tibialis (TPT), acromioclavicular joint (ACJ), and medial tibiofemoral joint (TFJ) spaces on two volunteer models. After positioning, a truncated steel needle was attached to the skin and parallel to the palpable structure, and the position of the steel needle relative to the designated structure was assessed by ultrasound imaging, using the Cohen kappa test to study the inter-rater agreement. The results showed that the assessor’s Kappa coefficient for judging the location of all structures was 0.816, LHB was 1.00, TPT was 0.912, ACJ gap was 0.796, and TFJ medial space was 0.844, and the success rate of palpation for TPT was 62.2%, TFJ medial space was 37.8%, ACJ clearance was 24.3%, and LHB was 8.1%. In conclusion, the teaching methods of anatomy and palpation skills need further improvement, and ultrasound imaging is an effective tool for assessing palpation skills.
Collapse
Affiliation(s)
- Peizhen Huang
- Department of Ultrasound and Imaging, Wenzhou Central Hospital, Wenzhou, China
| | - Bin Zheng
- Wenzhou Medical University, Wenzhou, China
| | - Shan Liu
- Wenzhou Medical University, Wenzhou, China
| | - Lin Xu
- Wenzhou Medical University, Wenzhou, China
| | | | - Shubei Zhan
- Department of Ultrasound and Imaging, Wenzhou Central Hospital, Wenzhou, China
| |
Collapse
|
7
|
Ferreira APA, Zanier JFC, Santos EBG, Ferreira AS. Accuracy of Palpation Procedures for Locating the C1 Transverse Process and Masseter Muscle as Confirmed by Computed Tomography Images. J Manipulative Physiol Ther 2022; 45:337-345. [PMID: 36175313 DOI: 10.1016/j.jmpt.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the accuracy of palpation methods for locating the transverse processes of the first cervical vertebra and masseter muscle using radiographic images as the gold-standard method and the association between personal characteristics with the observed accuracy. METHODS This was a single-blinded, diagnostic accuracy study. Ninety-five participants (49 women, 58 ± 16 years of age) were enrolled in this study. A single examiner palpated the neck and face region of all participants to identify the transverse processes of the first cervical vertebra and masseter muscles bilaterally. In sequence, participants underwent a multislice computed tomography scan for assessment of the superimposed inner body structure. Two radiologists assessed the computed tomography images using the same criteria and were blinded regarding each other's assessment and the anatomic landmarks under investigation. The palpation accuracy was calculated as the proportion of the correctly identified landmarks in the studied sample. The correlation of the palpation outcome (correct = 1; incorrect = 0) with age, sex (male = 1; female = 0), and body mass index was investigated using the point-biserial correlation coefficient. RESULTS The right and left transverse processes were correctly located in 76 (80%) and 81 (85%) participants, respectively, and bilaterally in 157 events (83%), as evaluated by the consensus of the 2 radiologists. The masseter muscles were correctly localized bilaterally in 95 of 95 (100%) participants. Body mass showed statistical evidence of a weak, positive correlation with the correct location of the transverse processes of the first cervical vertebra at the right body side (r = .219; 95% confidence interval, 0.018-0.403; P = .033). CONCLUSION Palpation methods used in this study accurately identified the location of the first cervical vertebra spinous processes and the masseter muscles.
Collapse
Affiliation(s)
- Ana Paula A Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, Rio de Janeiro, Brazil; Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy; Visiting Fellow, ARCCIM, University of Technology Sydney, Sydney, Australia; Instituto Brasileiro de Osteopatia, Rio de Janeiro, Brazil.
| | - José Fernando C Zanier
- University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduardo Brown G Santos
- University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arthur S Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, Rio de Janeiro, Brazil.
| |
Collapse
|
8
|
Aranceta-Garza A, Russo A, D'Emanuele S, Serafino F, Merletti R. High Density Surface Electromyography Activity of the Lumbar Erector Spinae Muscles and Comfort/Discomfort Assessment in Piano Players: Comparison of Two Chairs. Front Physiol 2021; 12:743730. [PMID: 34925054 PMCID: PMC8671302 DOI: 10.3389/fphys.2021.743730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/04/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: At a professional level, pianists have a high prevalence of playing-related musculoskeletal disorders. This exploratory crossover study was carried out to assess and compare quantitatively [using high density surface electromyography (HDsEMG)], and qualitatively (using musculoskeletal questionnaires) the activity of the lumbar erector spinae muscles (ESM) and the comfort/discomfort in 16 pianists sitting on a standard piano stool (SS) and on an alternative chair (A-chair) with lumbar support and a trunk-thigh angle between 105° and 135°. Materials and Methods: The subjects played for 55 min and HDsEMG was recorded for 20 s every 5 min. For the quantitative assessment of the muscle activity, the spatial mean of the root mean square (RMSROA) and the centroid of the region of activity (ROA) of the ESM were compared between the two chairs. For the qualitative assessment, musculoskeletal questionnaire-based scales were used: General Comfort Rating (GCR); Helander and Zhang’s comfort (HZc) and discomfort (HZd); and Body Part Discomfort (BPD). Results: When using the A-chair, 14 out of 16 pianists (87.5%) showed a significantly lower RMSROA on the left and right side (p < 0.05). The mixed effects model revealed that both chairs (F = 28.21, p < 0.001) and sides (F = 204.01, p < 0.001) contributed to the mean RMSROA variation by subject (Z = 2.64, p = 0.004). GCR comfort indicated that participants found the A-Chair to be “quite comfortable,” and the SS to be “uncomfortable.” GCR discomfort indicated that the SS caused more numbness than the A-Chair (p = 0.05) and indicated the A-Chair to cause more feeling of cramps (p = 0.034). No difference was found on HZc (p = 0.091) or HZd (p = 0.31) between chairs. Female participants (n = 9) reported greater comfort when using the A-Chair than the SS (F = 7.09, p = 0.01) with respect to males. No differences between chairs were indicated by the BPD assessment. Conclusion: It is concluded that using a chair with lumbar support, such as the A-chair, will provide greater comfort, less exertion of the ESM and less discomfort than the standard piano stool.
Collapse
Affiliation(s)
- Alejandra Aranceta-Garza
- Biomedical Engineering, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Alessandro Russo
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Samuel D'Emanuele
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,School of Exercise and Sport Sciences, University of Turin, Turin, Italy
| | - Francesca Serafino
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy.,Montecatone Rehabilitation Institute S.p.A., Imola, Italy
| | - Roberto Merletti
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| |
Collapse
|
9
|
Frey M, Barrett M, De Carvalho D. Effect of a dynamic seat pan design on spine biomechanics, calf circumference and perceived pain during prolonged sitting. APPLIED ERGONOMICS 2021; 97:103546. [PMID: 34399370 DOI: 10.1016/j.apergo.2021.103546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 07/11/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
This study investigates the effects of a dynamic seat pan design on sitting biomechanics, perceived pain and seat movement compared to a control. Thirty male participants were recruited for two experimental sessions consisting of a 2-h sitting exposure (standardized typing task). Spine angles, back muscle activity, perceived pain and calf circumference were measured pre and post exposure. Sitting in the dynamic condition resulted in lower pain ratings (p = 0.031), decreased calf circumference (p < 0.001), lower average seat pressure (p < 0.001), and greater seat contact area (p = 0.003) compared to the control. Spine angles and low back EMG for all 6 muscles showed no significant differences between chair conditions. These results suggest this dynamic seat pan design is effective at decreasing several negative components associated with sitting for the occupant. Future work should examine the longer-term effects of dynamic office chair features in the field setting with a more generalizable population.
Collapse
Affiliation(s)
- M Frey
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - M Barrett
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - D De Carvalho
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
| |
Collapse
|
10
|
Gaudreault N, Lebel K, Bédard S, Daigle F, Venne G, Balg F. Using ultrasound imaging to assess novice physiotherapy students' ability to locate musculoskeletal structures with palpation. Physiotherapy 2021; 113:53-60. [PMID: 34563915 DOI: 10.1016/j.physio.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Use ultrasound imaging to assess success rates of novice physiotherapy students attempting to locate two tendons and two joint spaces using palpation. DESIGN Cross-sectional study. SETTING Master of physiotherapy program at an academic institution. PARTICIPANTS Twenty-two end of first-year physiotherapy students. METHODS Participants were asked to palpate and locate the long head of the biceps (LHBT) and tibialis posterior (PTT) tendons as well as the acromioclavicular joint (ACJ) and medial tibiofemoral joint (TFJ) spaces on two human models. A truncated needle was taped onto the skin, parallel to the palpated structure. Ultrasound imaging was used to assess the position of the needle relative to the structures. MAIN OUTCOME MEASURES Success or failure was determined based on a judgment call on the needle position relative to the targeted structure on the ultrasound images. Inter-evaluator agreement for judgment criteria was investigated using Cohen's kappa tests and success rates subsequently calculated. RESULTS Kappa coefficients were 1.00 for all structures collectively, 1.00 for LHBT and PTT tendons, 1.006 for ACJ, and 0.79 for TFJ. Palpation success rates were: 9% for LHBT, 64% for PTT, 23% for ACJ, and 31% for medial TFJ. CONCLUSION These results highlight the fact that there is room for improvement in anatomy and palpation skill teaching methods and ultrasound imaging is valuable tool to assess this important skill.
Collapse
Affiliation(s)
- Nathaly Gaudreault
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, J1H 5N4, Canada.
| | - Karina Lebel
- Department of Electrical and Computer Engineering, Faculty of Engineering, University of Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC J1K 2R1, Canada
| | - Sonia Bédard
- Orthopedic Surgery Division, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, J1H 5N4, Canada
| | - Frédériqu Daigle
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, J1H 5N4, Canada
| | - Gabriel Venne
- Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, 845 Rue Sherbrooke Ouest, Montréal, H3A 0G4, Canada
| | - Frédéric Balg
- Orthopedic Surgery Division, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, J1H 5N4, Canada
| |
Collapse
|
11
|
Roytman GR, Selby S, Cantu J, Cramer GD. A Novel and Accurate Palpation Method for Identification of the L4 Spinous Process: A Preliminary Study of Accuracy. J Manipulative Physiol Ther 2021; 44:398-407. [PMID: 34429213 DOI: 10.1016/j.jmpt.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 09/19/2020] [Accepted: 03/30/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess a novel method of lumbar spinous process (SP) palpation by using magnetic resonance imaging (MRI) high-signal marker reference standards for verification. METHODS Clinicians (doctors of chiropractic) in this study used either: (1) the standard/traditional method of identifying the L4 SP using the supracristal plane (n = 14) or (2) a novel method that manually induced sacral motion to identify the L5 and then the L4 SP (n = 54). The clinicians, blinded to the results of each other, used a grease pencil to mark the location identified as the L4 SP. An MRI high-signal marker then was taped across this location. The MRI scans were assessed by a radiologist, blinded to the palpation method, who extended a line posteriorly from the superior and inferior extent of the L4 SP and determined whether the high-signal marker was within the lines bordering the L4 SP (ie, "on-target"). RESULTS Palpation using the traditional method showed a 35.7% accuracy, with 5 of 14 "on target" and all "off target" being too superior. Palpation using the novel method showed 77.8% accuracy, with 42 of 54 "on target" and 3 "off target" being too superior and 9 "off target" too inferior. CONCLUSIONS The novel method performed better than the traditional method. The novel method shows promise. Additional prospective research should be conducted to fully assess the accuracy of the novel method compared with traditional methods of palpation.
Collapse
Affiliation(s)
- Gregory R Roytman
- Research Department, National University of Health Sciences, Lombard, Illinois
| | - Scott Selby
- Research Department, National University of Health Sciences, Lombard, Illinois; Private Practice, Wheaton, Illinois
| | - Joe Cantu
- Research Department, National University of Health Sciences, Lombard, Illinois; Private Practice, Charlottesville, Virginia
| | - Gregory D Cramer
- Research Department, National University of Health Sciences, Lombard, Illinois.
| |
Collapse
|
12
|
Clark NG, Hill CJ, Koppenhaver SL, Massie T, Cleland JA. The effects of dry needling to the thoracolumbar junction multifidi on measures of regional and remote flexibility and pain sensitivity: A randomized controlled trial. Musculoskelet Sci Pract 2021; 53:102366. [PMID: 33831698 DOI: 10.1016/j.msksp.2021.102366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dry needling (DN) has been consistently shown to decrease pain sensitivity and increase flexibility local to the site of treatment, however it is unclear whether these effects are limited to the region of treatment or can be observed remote to the area of treatment. OBJECTIVE To determine the immediate, short-term effects of DN to the thoracolumbar junction on regional and remote flexibility, and to observe if changes in pain sensitivity can occur remote to site of treatment. DESIGN Double-blind randomized clinical trial. METHODS Fifty-four subjects with low back pain and decreased length in at least one hamstring were randomized to receive either DN or sham DN to the T12 and L1 multifidi. Participants underwent regional (fingertip-to-floor) and remote flexibility (passive knee extension, passive straight leg raise) and pressure pain threshold (PPT) testing of the upper and lower extremity before, immediately after and 1 day after treatment. ANCOVAs were used to analyze flexibility data, with the covariate of pre-treatment values. Paired t-tests were used for difference in remote pain sensitivity. RESULTS Statistically larger improvements in regional flexibility, but not remote flexibility, were observed immediately post-treatment in those who received DN than in those receiving sham DN (p = .0495; adjusted difference 1.2, 95% CI 0.002-2.3). Differences between upper and lower extremity PPT were not significant. CONCLUSION DN can potentially have immediate changes in regional flexibility, but effects are not sustained at 24-h follow-up. DN may not affect remote flexibility or segmental pain sensitivity.
Collapse
Affiliation(s)
- Nicole G Clark
- Stefani Doctor of Physical Therapy Program, University of Saint Mary, 4100 South 4th St, Leavenworth, KS, 66048, USA.
| | - Cheryl J Hill
- Doctor of Physical Therapy Program, Dr. Pallavi Patel College of Healthcare Sciences, Nova Southeastern University, 3200 South University, Dr. Ft. Lauderdale, FL, 33328, USA.
| | - Shane L Koppenhaver
- Baylor University, Doctoral Program in Physical Therapy, 1 Bear Place #97264, Waco, TX, 76798, USA.
| | - Thomas Massie
- Stefani Doctor of Physical Therapy Program, University of Saint Mary, 4100 South 4th St, Leavenworth, KS, 66048, USA.
| | - Joshua A Cleland
- Director of Research and Faculty Development, Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University, 136 Harrison Ave, Boston, MA, 02111, USA.
| |
Collapse
|
13
|
Alexander N, Rastelli A, Webb T, Rajendran D. The validity of lumbo-pelvic landmark palpation by manual practitioners: A systematic review. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2020.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
14
|
Gomez-Rice A, Madrid C, Izquierdo E, Marco-Martínez F, Tresguerres JAF, Sanchez-Mariscal F. Photographic sagittal plane analysis and its clinical correlation after surgery for adult spinal deformity: a preliminary study. Spine Deform 2021; 9:501-514. [PMID: 33136266 DOI: 10.1007/s43390-020-00237-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study is to determine the correlation between photographic sagittal parameters and patient-reported outcome measures (PROM) results in adult patients operated on spinal deformity. METHODS Non-concurrent prospective study. INCLUSION CRITERIA age at surgery older than 25, minimum 2-year follow-up after a 5 or more level fusion for adult spinal deformity (ASD). Full body lateral standing photographs were taken with adhesive markers placed on ten bony landmarks. SRS-22 and SF-36 questionnaires were completed for every patient. The following photographic parameters were measured: lumbar angle, lumbar curve, thoracic inclination (TI), trunk angle, pelvic tilt, head angle, neck angle, cervicothoracic angle, lumbar vector angle (LVA), dorsal vector angle (DVA), cervical vector angle (CVA), cranial pelvic angle (CrPA), cranial sacral angle (CrSA), fibular inclination angle (FIA) and cranial sagittal vertical axis measured to sacrum (Cr-S), greater trochanter (Cr-GT), knee (Cr-K) and ankle (Cr-A). RESULTS 65 patients (58 female) operated on ASD in a single institution were included. Age at surgery was 61 years (26-67). Postoperative follow-up was 53 months (24-120). Spearman rank order test showed several significant (p ≤ 0.01) correlations. After multivariate linear regression analysis age, LVA and TI remained as predictors for SRS image scores (corrected r2 0.41), LVA for SRS satisfaction (corrected r2 0.27), CrPA and age for SRS total scores (corrected r2 0.33), FIA and age for SF36 physical functioning (corrected r2 0.36) and CrSA for SF36 role physical (corrected r2 0.14). CONCLUSIONS Some sagittal photographic parameters may predict mid-term clinical results after ASD surgery.
Collapse
Affiliation(s)
- Alejandro Gomez-Rice
- Hospital Universitario Ramon y Cajal, Carretera M-607, km. 9.100, 28034, Madrid, Spain. .,Complutense University of Madrid, Madrid, Spain.
| | | | | | - Fernando Marco-Martínez
- Hospital Universitario Clínico San Carlos, Madrid, Spain.,Department of Surgery, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Jesús A F Tresguerres
- Department of Physiology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | | |
Collapse
|
15
|
Cushman DM, Scholl LV, Ludlow M, Cunningham S, Teramoto M. Accuracy of rib palpation for dry needling of deep periscapular musculature, measured with ultrasound. J Bodyw Mov Ther 2020; 26:7-11. [PMID: 33992299 DOI: 10.1016/j.jbmt.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/07/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Dry needling of the periscapular musculature is a procedure commonly performed by physical therapists. Needling of the deep musculature may be challenging, and use of a thoracic rib as a "backstop" is often applied to prevent inadvertent puncture of the pleura. The aim of this study was to: 1) To examine the accuracy rate of experienced physical therapists in identifying a mid-scapular thoracic rib using palpation, 2) to understand patient characteristics that affect the accuracy rate, and 3) to examine if therapist confidence levels were associated with palpatory accuracy. METHODS Two experienced physical therapists attempted to palpate a thoracic rib in the mid-scapular region of healthy participants (n = 101 subjects, 202 ribs), and self-reported their level of confidence in an accurate palpation. Their accuracy was verified with ultrasonography. RESULTS The two physical therapists were accurate on 73.3% of palpations and did not differ in accuracy (72.0% vs. 75.0%, p = 0.747). The only ultrasonographic or subject characteristic measurement that correlated with improved accuracy was a reduced muscle thickness (p = 0.032). Therapists' self-reported confidence levels did not correlate to actual accuracy (p = 0.153). DISCUSSION Physical therapists should be aware that palpation of a thoracic rib may not be as accurate as it may seem. The greater thickness of muscle in the area reduces the accuracy of accurate palpation. CONCLUSION Dry needling of the periscapular muscles should be done with caution if using a rib as a "blocking" technique.
Collapse
Affiliation(s)
- Daniel M Cushman
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
| | | | - Monica Ludlow
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
| | - Shellie Cunningham
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Masaru Teramoto
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
16
|
Burkhart K, Grindle D, Bouxsein ML, Anderson DE. Between-session reliability of subject-specific musculoskeletal models of the spine derived from optoelectronic motion capture data. J Biomech 2020; 112:110044. [PMID: 32977297 DOI: 10.1016/j.jbiomech.2020.110044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/30/2020] [Accepted: 09/01/2020] [Indexed: 01/18/2023]
Abstract
This study evaluated the between-session reliability of creating subject-specific musculoskeletal models with optoelectronic motion capture data, and using them to estimate spine loading. Nineteen healthy participants aged 24-74 years underwent the same set of measurements on two separate occasions. Retroreflective markers were placed on anatomical regions, including C7, T1, T4, T5, T8, T9, T12 and L1 spinous processes, pelvis, upper and lower limbs, and head. We created full-body musculoskeletal models with detailed thoracolumbar spines, and scaled these to create subject-specific models for each individual and each session. Models were scaled from distances between markers, and spine curvature was adjusted according to marker-estimated measurements. Using these models, we estimated vertebral compressive loading for five different standardized postures: neutral standing, 45˚ trunk flexion, 15˚ trunk extension, 20˚ lateral bend to the right, and 45˚ axial rotation to the right. Intraclass correlation coefficients (ICCs) and standard error of measurement were calculated as measures of between-session reliability and measurement error, respectively. Spine curvature measures showed excellent reliability (ICC = 0.79-0.91) and body scaling segments showed fair to excellent reliability (ICC = 0.46-0.95). We found that musculoskeletal models showed mostly excellent between-session reliability to estimate spine loading, with 91% of ICC values > 0.75 for all activities. This information is a necessary precursor for using motion capture data to estimate spine loading from subject-specific musculoskeletal models, and suggests that marker data will deliver reproducible subject-specific models and estimates of spine loading.
Collapse
Affiliation(s)
- Katelyn Burkhart
- Harvard-MIT Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge 02139, MA, United States; Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston 02215, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston 02115, MA, United States
| | - Daniel Grindle
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston 02215, MA, United States; Division of Engineering Mechanics, Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Mary L Bouxsein
- Harvard-MIT Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge 02139, MA, United States; Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston 02215, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston 02115, MA, United States
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston 02215, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston 02115, MA, United States.
| |
Collapse
|
17
|
Sarcevic ZZ, Tepavcevic A. Association Among Dyskinesia of the Lumbar Spine Segment, Inclination Angle of the Lumbosacral Spine, and Low Back Pain in Young Athletes: A Predictive Correlational Study. J Manipulative Physiol Ther 2020; 43:646-654. [PMID: 32861522 DOI: 10.1016/j.jmpt.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 10/28/2019] [Accepted: 12/05/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This predictive correlational study aimed to investigate the association among low back pain (LBP), dyskinesia of the lumbosacral spine segment (determined by inertial sensors), and inclination angles: the inclination angle of the lumbosacral spine (alpha), the inclination angle of the thoracolumbar spine (beta), and the inclination angle of the upper thoracic section (gamma). Our hypothesis was that young athletes with LBP had a particular dyskinesia: nonphysiological movements of the lumbosacral segment of the spine. METHODS The study group consisted of 108 young athletes aged 10 to 16 years (male/female 44%/56%; 12.3 ± 1.8 years; 160.1 ± 12.0 cm; 51.1 ± 13.8 kg; 4.3 ± 2.4 training years; 3.7 ± 2.1 training h/wk). The alpha, beta, and gamma angles were measured with a digital inclinometer. The position of the lumbosacral segment at the maximum extension was determined with the inertial sensors, positioned at the 11th thoracic vertebra (T11), the third lumbar spine vertebra (L3), and the second sacral spine vertebra (S2). The data were analyzed using Student's t tests, tetrachoric correlation coefficients, and logistic regression. RESULTS There was a significant statistical difference in alpha angles (t = 9.4, P < .001) and lumbar positions in extension (t = 6.4, P < .001) between groups with LBP and without LBP. The logistic regression indicated that LBP in young athletes was significantly associated with the increased alpha angle and nonphysiological lumbar position in extension measured by a sensor at the third lumbar spine vertebra. CONCLUSION There was a strong association among LBP, increased inclination angle of the lumbosacral spine, and dyskinesia of the lumbar spine segment in young athletes.
Collapse
|
18
|
Mehyar F, Wilson SE, Staggs VS, Aoyagi K, Sharma NK. Quantifying Lumbar Mobilization With Inertial Measurement Unit. J Manipulative Physiol Ther 2020; 43:114-122. [PMID: 32482432 DOI: 10.1016/j.jmpt.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 04/02/2019] [Accepted: 04/07/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Lumbar mobilization is a standard intervention for the management of low back pain, yet ways to quantify lumbar mobilization are limited. An inertial measurement unit (IMU) is a small and inexpensive device that can be used to quantify lumbar mobilization. The objective of this study was to determine the validity and reliability of an IMU in measuring the amplitude of displacement of a clinician's hand movement during oscillatory lumbar mobilization. METHODS An IMU was secured on a clinician's hand during application of mobilization forces at the L4 segment of 16 healthy participants. The validity of the IMU was tested against common laboratory methods of measurements (force plate and motion capture system). The reliability of the IMU measurements was determined between 2 clinicians (inter-rater reliability) and between 2 sessions (intra-rater reliability) by calculating percent error of measurement (%e) and limits of agreement (LOA). The reliability was considered high when |%e| ≤ 10% and |LOA| ≤ 20%; moderate when |%e| 10% to 20% and |LOA| 21% to 40%; and non-acceptable when |%e| > 20% and |LOA| > 40%. RESULTS The IMU measurements had high correlation with the force plate measurements (rs = 0.94) and high agreement with the motion capture system measurements (%e = 4%, LOA = -11% and 20%). Both the inter-rater reliability (%e = 6%, LOA = -25% and 37%) and the intrarater reliability (%e = -1%, LOA = -29% and 27%) of IMU measurements were moderate. CONCLUSION The IMU seems to be a valid device to measure the amplitude of a clinician's hand movement. The moderate reliability found in this study may not reflect poor reliability of the IMU as much as inconsistency in reapplication of lumbar mobilization.
Collapse
Affiliation(s)
- Fahed Mehyar
- Department of Physical Therapy, Eastern Washington University, Cheney, Washington
| | - Sara E Wilson
- Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas
| | - Vincent S Staggs
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri; School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Kosaku Aoyagi
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Neena K Sharma
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas.
| |
Collapse
|
19
|
Petersson M, Abbott A. Lumbar interspinous pressure pain threshold values for healthy young men and women and the effect of prolonged fully flexed lumbar sitting posture: An observational study. World J Orthop 2020; 11:158-166. [PMID: 32280605 PMCID: PMC7138865 DOI: 10.5312/wjo.v11.i3.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/26/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is a common condition with large burden worldwide. Exposure to prolonged sitting with a flexed lumbar posture has been suggested in the literature to be a potential risk factor for self-reported LBP. No study has previously investigated whether exposure to prolonged flexed sitting posture provokes discomfort/pain and decreased interspinous pressure pain thresholds for healthy young men and women without back pain, despite this being a suggested risk factor for LBP.
AIM To investigate whether sitting in a prolonged flexed lumbar posture provokes discomfort and lowers interspinous pressure pain thresholds in the lumbar spine for healthy young men and women without previous LBP.
METHODS This is a an observational before and after study of 26 participants (13 men, 13 women) between 20-35 years old. Algometry was used to examine the pain threshold for pressure applied between spinous processes of the lumbar spine L1-L5. Pressure algometer measures were performed in prone before and after participants were instructed to sit in a fully flexed posture for a maximum of 15 min or until discomfort was experienced in the low back (Borg CR10 = 7/10). Wilcoxon signed-rank test was used for analyze values from the before and after test conditions. Mann-Whitney U test was used to investigate potential gender difference.
RESULTS Fully flexed lumbar spine sitting posture up to 15 min provoked temporary discomfort but the proportion of participants experiencing discomfort 7/10 in the low back was 62%. For all pain pressure threshold locations tested, there was a significant difference for the study population with moderate-large decreased (r = -0.56) pressure pain threshold after exposure to prolonged flexed sitting posture (P < 0.01). Comparisons between gender did not show any significant difference.
CONCLUSION The result showed that exposure to fully flexed lumbar sitting posture for up to 15 min produced temporary discomfort in the low back in young healthy adults with no previous history of LBP and significantly reduced lumbar interspinous pressure pain thresholds. No gender-based differences were observed.
Collapse
Affiliation(s)
- Martin Petersson
- Department of Physiotherapy Gripen, Värmland Country Council, Karlstad SE-65224, Sweden
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping SE-58183, Sweden
| | - Allan Abbott
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping SE-58183, Sweden
| |
Collapse
|
20
|
Consorti G, Basile F, Pugliese L, Petracca M. Interrater Reliability of Osteopathic Sacral Palpatory Diagnostic Tests Among Osteopathy Students. J Osteopath Med 2018; 118:637-644. [DOI: 10.7556/jaoa.2018.132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Context
Somatic dysfunctions are a key element of osteopathic practice. The evaluation of somatic dysfunctions is achieved by assessment of the TART (tissue texture abnormality, asymmetry, restriction of motion, tenderness) parameters. The reliability of a diagnostic method is the crux of successful treatment. Interrater reliability of osteopathic palpatory diagnostic tests have been studied on different anatomical areas, but there are no studies on the evaluation of all of the TART parameters on the sacrum.
Objective
To evaluate the interrater reliability of osteopathic sacral palpatory diagnostic tests. The hypothesis was that 3 trained osteopathy students at the end of their curriculum could achieve at least moderate agreement on osteopathic sacral palpatory diagnostic tests.
Methods
Three students from the Centre pour l’Étude, la Recherche et la Diffusion Ostéopathiques school in Rome, Italy, at the end of their curriculum participated as raters and received consensus training. Eligible subjects among students of the same school were recruited on a voluntary basis to be tested. All of the raters tested the sacrum by evaluating the TART parameters on every subject for 3 minutes. Raters were blinded to the other raters’ findings. Interrater reliability was evaluated using Fleiss κ statistics.
Results
Fifty-two subjects (20 women) were enrolled in the study. Mean (SD) age was 25.9 (7.03) years; height, 1.73 (0.09) ms; weight, 68.73 (14.2) kg; and body mass index, 22.66 (3.58). Agreement was fair for tissue texture abnormality (κ=0.28), asymmetry (κ=0.29), restriction of motion (κ=0.32), and tenderness (κ=0.34); agreement was slight for landmark position (κ=0.06) and diagnosis of somatic dysfunction (κ=0.17).
Conclusion
Results showed a level of agreement ranging from slight to fair in the assessment of the TART parameters among raters, who were in their last year of osteopathy school. The tenderness parameter was the most reliable. Our findings are consistent with other interrater reliability studies carried out in different body regions, contributing to show an overall heterogeneous level of diagnostic reliability in osteopathy.
Collapse
|
21
|
Takács M, Orlovits Z, Jáger B, Kiss RM. Comparison of spinal curvature parameters as determined by the ZEBRIS spine examination method and the Cobb method in children with scoliosis. PLoS One 2018; 13:e0200245. [PMID: 29985957 PMCID: PMC6037360 DOI: 10.1371/journal.pone.0200245] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 05/28/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The most common and gold standard method to diagnose and follow-up on scoliosis treatment is to capture biplanar X-ray images and then use these to determine the sagittal frontal spinal curvature angles by the Cobb method. Reducing exposure to radiation is an important aspect for consideration, especially regarding children. The ZEBRIS spinal examination method is an external, non-invasive measurement method that uses an ultrasound-based motion analysis system. The aim of this study is to compare angle values of patients with adolescent idiopathic scoliosis (AIS) determined by the ZEBRIS spine examination method with the angle values defined by the gold standard Cobb method on biplanar X-ray images. METHODS Subjects included 19 children with AIS (mean age 14.5±2.1 years, range 8-16 years, frontal plane thoracic Cobb angle 19.95±10.23°, thoracolumbar/lumbar angle 16.57±10.23°). The thoracic kyphosis and lumbar lordosis in the sagittal plane and the thoracic and lumbar scoliosis values were calculated by the Cobb method on biplanar X-ray images. The sagittal frontal spinal curvature angles were calculated from the position of the processus spinosus of 19 vertebrae, as determined by the ZEBRIS spine examination method. The validity of the ZEBRIS spine examination method was evaluated with Bland-Altman analyses between the sagittal and frontal spinal curvature parameters calculated from data determined by the ZEBRIS spine examination method and data obtained by the Cobb method on the X-ray images. RESULTS AND DISCUSSION Thoracic spinal curvature angles in sagittal and in frontal planes can be measured with sufficient accuracy. The slopes of the linear regression lines for thoracic kyphosis (TK) and thoracic scoliosis (TSC) are close to one (1.00 and 0.79 respectively), and the intercept values are below 5 degrees. The correlation between the TK and TSC values determined by the two methods is significant (p = 0.000) and excellent (rTK = 0.95, rTSC = 0.85). The differences are in the limit of agreement. The lumbar lordosis (LL) in the sagittal plane shows a very good correlation (rLL = 0.76); however the differences between the angles determined by the two methods are out of the limit of agreement in patients with major lumbar lordosis (LL≥50°). The thoracolumbar/lumbar spinal curvature angles in the frontal plane determined by ZEBRIS spine examination were underestimated at curvatures larger than 15°, mainly due to the rotational and pathological deformities of the scoliotic vertebrae. However, the correlation between lumbar scoliosis (LSC) values determined by the two methods is significant (p = 0.000) and excellent (rLSC = 0.84), the slopes are below one (0.71), the intercept values are below 5 degrees, and the differences between the angles determined by the two methods are within the limits of agreement. We could conclude that ZEBRIS spinal examination is a valid and reliable method for determination of sagittal and frontal curvatures during the treatment of patients with scoliosis. However, it cannot replace the biplanar X-ray examination for the visualization of spinal curvatures in the sagittal and frontal planes and the rotation of vertebral bodies during the diagnosis and annual evaluation of the progression.
Collapse
Affiliation(s)
- Mária Takács
- Department of Orthopedics, MÁV Hospital Szolnok, Szolnok, Hungary
| | - Zsanett Orlovits
- Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Bence Jáger
- Department of Structural Engineering, Budapest University of Technology and Economics, Budapest, Hungary
| | - Rita M. Kiss
- Department of Mechatronics, Optics and Mechanical Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
- * E-mail:
| |
Collapse
|
22
|
Raffalt PC, Nielsen LR, Madsen S, Munk Højberg L, Pingel J, Nielsen JB, Wienecke J, Alkjær T. Day-to-day reliability of gait characteristics in rats. J Biomech 2018. [PMID: 29530501 DOI: 10.1016/j.jbiomech.2018.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The purpose of the present study was to determine the day-to-day reliability in stride characteristics in rats during treadmill walking obtained with two-dimensional (2D) motion capture. Kinematics were recorded from 26 adult rats during walking at 8 m/min, 12 m/min and 16 m/min on two separate days. Stride length, stride time, contact time, swing time and hip, knee and ankle joint range of motion were extracted from 15 strides. The relative reliability was assessed using intra-class correlation coefficients (ICC(1,1)) and (ICC(3,1)). The absolute reliability was determined using measurement error (ME). Across walking speeds, the relative reliability ranged from fair to good (ICCs between 0.4 and 0.75). The ME was below 91 mm for strides lengths, below 55 ms for the temporal stride variables and below 6.4° for the joint angle range of motion. In general, the results indicated an acceptable day-to-day reliability of the gait pattern parameters observed in rats during treadmill walking. The results of the present study may serve as a reference material that can help future intervention studies on rat gait characteristics both with respect to the selection of outcome measures and in the interpretation of the results.
Collapse
Affiliation(s)
- Peter C Raffalt
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Louise R Nielsen
- Center of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Stefan Madsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Laurits Munk Højberg
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Pingel
- Center of Neuroscience, University of Copenhagen, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Jens Bo Nielsen
- Center of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Wienecke
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Tine Alkjær
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
23
|
Snider KT, Redman CL, Edwards CR, Bhatia S, Kondrashova T. Ultrasonographic Evaluation of the Effect of Osteopathic Manipulative Treatment on Sacral Base Asymmetry. J Osteopath Med 2018; 118:159-169. [DOI: 10.7556/jaoa.2018.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Context
Patients with low back pain (LBP) may receive osteopathic manipulative treatment (OMT) to resolve or manage their pain. The indication for OMT for patients with LBP is the presence of somatic dysfunction, diagnosed using palpatory examination. Because palpatory findings commonly have poor interexaminer reliability, the current study used ultrasonography (US) to establish pre-OMT and post-OMT musculoskeletal measurements of relative asymmetry between pelvic and sacral bony landmarks.
Objective
To document objective musculoskeletal changes that occur in response to OMT using US and to compare palpatory assessment of landmark asymmetry with US assessment.
Methods
Sixty men and women aged 20 to 55 years with at least 1 episode of LBP in the past 2 weeks were assigned to a seated control, walking control, or OMT group (20 participants per group). Participants received an initial, bilateral US measurement of the skin to posterior superior iliac spine (SPSIS), skin to sacral base position (SBP), and sacral sulcus depth (SSD). Participants in seated control and OMT groups received a palpatory assessment of SBP and SSD prior to initial US assessment. After assessment, the seated control group sat in a waiting room for 30 minutes, the walking control group walked for 5 minutes, and the OMT group received OMT to address sacral base asymmetry using predominantly direct techniques for a maximum of 20 minutes. Participants then received a second US assessment of the same structures.
Results
Body mass index (BMI) was correlated with SPSIS (r=0.5, P=.001) and SBP (r=0.6, P<.001). More participants in seated control (75%) and OMT (65%) groups had an increase in asymmetry from first to second US assessment for SPSIS compared with participants in the walking control group (35%, P=.05). No significant differences were found between groups for absolute asymmetry or total change in asymmetry (all P>.10). The κ was −0.1 (95% CI, −0.2 to 0.03) for SBP and −0.01 (95% CI, −0.1 to 0.1) for SSD.
Conclusion
Musculoskeletal changes in SPSIS and SBP measurements related to OMT could not be readily identified using US. The SPSIS and SBP measurements were dependent on BMI, which may have affected the accuracy of US to detect small changes in asymmetry. Qualitative palpatory assessments did not correlate with US measurements. Further study is needed to identify US measurements that demonstrate change with OMT. (ClinicalTrials.gov number NCT02820701)
Collapse
|
24
|
Snider EJ, Pamperin K, Pazdernik V, Degenhardt BF. Influence of Transverse Process Landmark Localization on Palpation Accuracy of Lumbar Spine Models. J Osteopath Med 2018; 118:151-158. [PMID: 29480915 DOI: 10.7556/jaoa.2018.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context Accurate determination of transverse process displacement in the horizontal plane requires accurate transverse process landmark localization followed by accurate discrimination of asymmetry by the examiner's palpating digits. Objective To determine whether the accurate localization of transverse process landmarks influences overall accuracy of asymmetry determination in third-year osteopathic medical students evaluating covered lumbar spine models. Methods A class of third-year osteopathic medical students was split into 2 groups and asked to determine whether the right transverse processes of covered lumbar spine models were anterior or posterior relative to the left transverse process. The marked model group (group A) was provided covered models with black dots on the fabric covers over the transverse process landmarks, while the covered models given to the students in the unmarked model group (group B) had no markings. Both groups were asked to assess asymmetry differences from L1 to L5 on 2 models. Landmarks were randomized for asymmetry (ranging from 2 mm to 6 mm) and direction (anterior or posterior on the right side). The number of correct responses was modeled as a binomial random variable in a generalized linear model to compare the effects of marked vs unmarked models on accuracy of palpation. The predicted probability of correctly determining the direction of the asymmetry and 95% CIs were calculated. Results The probability of correctly identifying the direction of asymmetry was 0.89 (95% CI, 0.87-0.91) for group A and 0.74 (95% CI, 0.71-0.78) for group B, a 15 percentage point difference (OR, 1.2; 95% CI, 1.1-1.3; P<.001). Assuming accurate perception of digit asymmetry and accurate localization of landmarks are independent and correct answers are given only if both events occur, then students were more likely to accurately perceive digit asymmetry (0.89) than accurately localize landmarks (0.83=0.74/0.89). Overall, more students accurately identified the direction of asymmetry when the right transverse process was anterior (0.87; 95% CI, 0.84-0.90) than when it was posterior (0.81; 95% CI, 0.77-0.84) (OR, 1.6; 95% CI, 1.2-2.1; P=.001). Conclusions Student palpation accuracy was better when transverse process landmark localization was provided on the lumbar spine models than when it was not. Students were more likely to accurately perceive digit asymmetry than accurately localize the landmarks. Improving palpation accuracy requires developing educational methods to improve both accurate landmark localization and accurate digit asymmetry perception.
Collapse
|
25
|
Póvoa LC, Ferreira APA, Zanier JFC, Silva JG. Accuracy of Motion Palpation Flexion-Extension Test in Identifying the Seventh Cervical Spinal Process. J Chiropr Med 2018; 17:22-29. [PMID: 29628805 DOI: 10.1016/j.jcm.2017.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 10/17/2022] Open
Abstract
Objective The aim of this study was to evaluate the accuracy of a motion palpation procedure, the flexion-extension test, in localizing the spinous process of the seventh cervical vertebra (C7). Methods We analyzed 101 adult participants with metal markers that permitted the identification of the C7 spinous process. This analysis occurred during a flexion-extension test and was confirmed by radiography. Data sample characteristics were analyzed by descriptive statistics, and the relationship between independent variables (weight, height, sex, age, and body mass index [BMI]) and dependent variables (coincidence between the most prominent vertebra and the stationary vertebra, as determined by the flexion-extension test) was determined via logistic regression. Results The sample population was 48.5% male with a mean age of 56.8 years (standard deviation, ±14.9) and a mean BMI of 25.54 kg/m2 (standard deviation, ±5.5). In 54.5% of cases, the C7 spinous process was correctly identified by the flexion-extension test. The agreement between the flexion-extension test and radiography in accuracy of localization of the C7 spinous process was significant (P = .021), as was the correct localization of C7 (P = .05). Conclusion The localization of the C7 spinous process was more accurate in individuals with a BMI <25 kg/m2 and whose most prominent vertebra coincided with the stationary vertebra as determined by the flexion-extension test.
Collapse
Affiliation(s)
- Luciana C Póvoa
- Rehabilitation Science Postgraduate Program, Human Analysis Movement Lab, Augusto Motta University Center, Rio de Janeiro, Brazil.,Brazilian Osteopathic Institute, Rio de Janeiro, Brazil.,Department of Radiology, Estado do Rio de Janeiro Universtiy, Rio de Janeiro, Brazil.,Human Analysis Movement Lab, Praça das Nações, Rio de Janeiro, Brazil
| | - Ana P A Ferreira
- Rehabilitation Science Postgraduate Program, Human Analysis Movement Lab, Augusto Motta University Center, Rio de Janeiro, Brazil.,Brazilian Osteopathic Institute, Rio de Janeiro, Brazil.,Department of Radiology, Estado do Rio de Janeiro Universtiy, Rio de Janeiro, Brazil.,Human Analysis Movement Lab, Praça das Nações, Rio de Janeiro, Brazil
| | - José F C Zanier
- Department of Radiology, Estado do Rio de Janeiro Universtiy, Rio de Janeiro, Brazil
| | - Julio G Silva
- Human Analysis Movement Lab, Praça das Nações, Rio de Janeiro, Brazil.,Department of Physical Therapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
26
|
de Albuquerque PMNM, de Alencar GG, de Oliveira DA, de Siqueira GR. Concordance and Reliability of Photogrammetric Protocols for Measuring the Cervical Lordosis Angle: A Systematic Review of the Literature. J Manipulative Physiol Ther 2018; 41:71-80. [PMID: 29366490 DOI: 10.1016/j.jmpt.2017.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/09/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to examine and interpret the concordance, accuracy, and reliability of photogrammetric protocols available in the literature for evaluating cervical lordosis in an adult population aged 18 to 59 years. METHODS A systematic search of 6 electronic databases (MEDLINE via PubMed, LILACS, CINAHL, Scopus, ScienceDirect, and Web of Science) located studies that assessed the reliability and/or concordance and/or accuracy of photogrammetric protocols for evaluating cervical lordosis, compared with radiography. Articles published through April 2016 were selected. Two independent reviewers used a critical appraisal tool (QUADAS and QAREL) to assess the quality of the selected studies. RESULTS Two studies were included in the review and had high levels of reliability (intraclass correlation coefficient: 0.974-0.98). Only 1 study assessed the concordance between the methods, which was calculated using Pearson's correlation coefficient. To date, the accuracy of photogrammetry has not been investigated thoroughly. CONCLUSION We encountered no study in the literature that investigated the accuracy of photogrammetry in diagnosing hyperlordosis of cervical spine. However, both current studies report high levels of intra- and interrater reliability. To increase the level of evidence of photogrammetry in the evaluation of cervical lordosis, it is necessary to conduct further studies using a larger sample to increase the external validity of the findings.
Collapse
|
27
|
Levine D, Walker JR, Marcellin-Little DJ, Goulet R, Ru H. Detection of skin temperature differences using palpation by manual physical therapists and lay individuals. J Man Manip Ther 2018; 26:97-101. [PMID: 29686483 DOI: 10.1080/10669817.2018.1427908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objectives To evaluate the accuracy of detection of temperature differences among skin sites of lay individuals and manual physical therapists. Methods Forty-four manual physical therapists and 44 lay individuals were recruited. Subjects palpated two temperature-controlled surfaces that ranged in temperature between 30 and 35 °C and varied randomly by 1, 2, 3, 4, or 5 °C for 10 s. The subjects were then asked to identify the warmer pad. Results Accuracy increased with larger temperature differences. Accuracy of detection of 1 and 3 °C temperature differences was higher in manual physical therapists than lay individuals. Discussion Palpation can be used to accurately detecting temperature differences between sites and is more accurately performed by an experienced practitioner. Level of Evidence 3b.
Collapse
Affiliation(s)
- David Levine
- Department of Physical Therapy, University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - J Randy Walker
- Department of Physical Therapy, University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Denis J Marcellin-Little
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, CA, USA
| | - Ron Goulet
- Department of Mechanical Engineering, University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Hongyu Ru
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| |
Collapse
|
28
|
Ferreira APA, Póvoa LC, Zanier JFC, Machado DC, Ferreira AS. Sensitivity for palpating lumbopelvic soft- tissues and bony landmarks and its associated factors: A single-blinded diagnostic accuracy study. J Back Musculoskelet Rehabil 2017; 30:735-744. [PMID: 28453451 DOI: 10.3233/bmr-150356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Evidence on the diagnostic performance of palpatory methods and possible confounding factors is scarce. OBJECTIVES To examine the sensitivity of palpatory methods for location of lumbopelvic landmarks and to assess its association with personal characteristics. METHODS Eighty-three participants (41 men, 55.6 (16.5) years, 25.9 (4.8) kg/m2 [mean (SD)]) were enrolled in this single-blinded study. Fourteen body and softy-tissue landmarks were sequentially palpated from the spinous process of L4 to the ischial tuberosity. CT-scan images were used to assess what landmark was located. RESULTS Sensitivity for location was in range 22-86% for soft-tissues and 26-69% for bony landmarks. Reduction in sensitivity was observed from the quadratus lumborum to the inferior and lateral angle of the sacrum (86-26% and 75-33%, left and right sides, respectively). Palpations of L4 and L5 spinous processes were systematically more cephalic than other landmarks. Gender was weakly correlated to almost all landmarks (rpb= 0.333 or weaker). Body mass index was weakly correlated to the accurate location of ILAS and quadratus lumborum, great trochanter, PSIS, and piriformis (rpb=-0.307 or weaker). CONCLUSIONS Systematic and propagation errors were present using sequential palpatory methods. Palpation in men was more sensitive and higher BMI was associated with lower sensitivity for lumbopelvic landmarks.
Collapse
Affiliation(s)
- A P A Ferreira
- Instituto Brasileiro de Osteopatia, Centro, CEP 22440-901, RJ, Brasil.,Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Bonsucesso, CEP 21041-010, RJ, Brasil
| | - L C Póvoa
- Instituto Brasileiro de Osteopatia, Centro, CEP 22440-901, RJ, Brasil.,Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Bonsucesso, CEP 21041-010, RJ, Brasil
| | - J F C Zanier
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Vila Isabel, CEP 20551-030, RJ, Brasil
| | - D C Machado
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Vila Isabel, CEP 20551-030, RJ, Brasil
| | - A S Ferreira
- Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Bonsucesso, CEP 21041-010, RJ, Brasil
| |
Collapse
|
29
|
Analysis of 3D multi-segment lumbar spine motion during gait and prone hip extension. J Electromyogr Kinesiol 2017; 33:111-117. [DOI: 10.1016/j.jelekin.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/10/2017] [Accepted: 02/17/2017] [Indexed: 11/19/2022] Open
|
30
|
Whittle CJ, Flavell CA, Gordon SJ. Methodological consistency and measurement reliability of transversus abdominis real time ultrasound imaging in chronic low back pain populations: a systematic review. PHYSICAL THERAPY REVIEWS 2017. [DOI: 10.1080/10833196.2017.1287151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Connie Jean Whittle
- College of Healthcare Sciences, James Cook University, Douglas Campus , Townsville, Australia
| | - Carol Ann Flavell
- College of Healthcare Sciences, James Cook University, Douglas Campus , Townsville, Australia
| | - Susan Jayne Gordon
- College of Healthcare Sciences, James Cook University, Douglas Campus , Townsville, Australia
- School of Health Sciences, Flinders University , Bedford Park, Australia
| |
Collapse
|
31
|
Ferreira APA, Póvoa LC, Zanier JF, Ferreira AS. Locating the Seventh Cervical Spinous Process: Development and Validation of a Multivariate Model Using Palpation and Personal Information. J Manipulative Physiol Ther 2017; 40:89-97. [DOI: 10.1016/j.jmpt.2016.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/28/2016] [Accepted: 10/11/2016] [Indexed: 11/25/2022]
|
32
|
Ferreira APA, Póvoa LC, Zanier JF, Ferreira AS. Locating the Seventh Cervical Spinous Process: Accuracy of the Thorax-Rib Static Method and the Effects of Clinical Data on Its Performance. J Manipulative Physiol Ther 2017; 40:98-105. [DOI: 10.1016/j.jmpt.2016.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/28/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
|
33
|
Pagé I, Descarreaux M, Sobczak S. Development of a new palpation method using alternative landmarks for the determination of thoracic transverse processes: An in vitro study. Musculoskelet Sci Pract 2017; 27:142-149. [PMID: 27697392 DOI: 10.1016/j.math.2016.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 12/25/2022]
Abstract
Palpation methods (PMs) have been proposed to guide clinicians in locating the thoracic transverse processes (TTPs). However, no studies have assessed the validity of TTPs palpation or the added value of musculoskeletal ultrasound (MSU). The objectives of the present study were (1) to explore the validity of TTPs location using palpation as commonly performed by clinicians, (2) to develop an accurate and valid PM, and (3) to assess the added value of MSU. A standardized procedure was used on six cadavers. It consisted in the insertion of markers through the T3, T5, T6 and T8 TTPs and spinous processes, which were identified using palpation and MSU. First, a fresh cadaver was used to explore the validity of the common palpation method. Since poor validity was observed, one intermediate and a final PMs were tested on a total of five Thiel-embalmed specimens. A descriptive analysis was performed and agreement between MSU and the final PM was determined. The final PM led to the proper determination of all TTPs on three specimens with a mean error of 4 ± 1.8 mm in relation to the TTPs center. The coefficient of variations and root mean square errors were ≤0.15 and 0.21 mm, respectively. Bland-Altman plot showed no differences between palpation and MSU. In conclusion, this study reports the validity of a new PM using multiple landmarks to guide TTPs determination and for which MSU does not seem to add value in accuracy. These results may have important clinical implications for clinicians using palpation.
Collapse
Affiliation(s)
- Isabelle Pagé
- Département d'anatomie, Université du Québec à Trois-Rivières, 3351 boul. des Forges, CP. 500, Trois-Rivières, Québec, G9A 5H7, Canada; Groupe de Recherche sur les affections neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 boul. des Forges, CP. 500, Trois-Rivières, Québec, G9A 5H7, Canada.
| | - Martin Descarreaux
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, 3351 boul. des Forges, CP. 500, Trois-Rivières, Québec, G9A 5H7, Canada; Groupe de Recherche sur les affections neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 boul. des Forges, CP. 500, Trois-Rivières, Québec, G9A 5H7, Canada
| | - Stéphane Sobczak
- Département d'anatomie, Université du Québec à Trois-Rivières, 3351 boul. des Forges, CP. 500, Trois-Rivières, Québec, G9A 5H7, Canada; Groupe de Recherche sur les affections neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 boul. des Forges, CP. 500, Trois-Rivières, Québec, G9A 5H7, Canada
| |
Collapse
|
34
|
McKenna L, Cornwall X, Williams S. Differences in Scapular Orientation Between Standing and Sitting Postures at Rest and in 120° Scaption: A Cross-Sectional Study. PM R 2016; 9:579-587. [PMID: 27721004 DOI: 10.1016/j.pmrj.2016.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/15/2016] [Accepted: 09/17/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Scapular orientation may be influenced by static body posture (sitting and standing) and contribute to the development of shoulder pain. Therefore, a consistent body posture should be considered when assessing scapular orientation as well as enhancing optimal scapular positioning. OBJECTIVE To determine whether there are differences in scapular orientation between standing, neutral sitting, and habitual sitting, while adjusting for spinal posture. DESIGN A single group randomized repeated measures study. SETTING University laboratory. PARTICIPANTS Twenty-eight participants with shoulder pain were recruited from the community. METHODS Scapular orientation between standing and seated positions was compared, with the arm by the side and at 120° of glenohumeral scaption. Thoracic kyphosis and lumbar lordosis angles were used as covariates. MAIN OUTCOME MEASUREMENTS Scapular elevation, lateral translation, upward rotation, and posterior tilt. RESULTS Scapular orientation was marginally but significantly different between sitting postures for lateral translation (mean 0.5 cm; 95% confidence interval [95% CI] 0.2-0.7 cm); P < .001), upward rotation (mean 3°; 95% CI 1.1-5.0°; P < .001), and posterior tilt (mean 2.3°; 95% CI 0.2-4.3°; P = .009) in the arm by side position. A small-but-significant difference between standing and neutral sitting was found for upward rotation (mean 1.8°; 95% CI 0-3.7°; P = .02), and between standing and habitual sitting for lateral translation (mean 0.6 cm; 95% CI 0-1.1 cm; P =.02) in the arm by side position. CONCLUSIONS The results of this study suggest that scapular orientation can be slightly affected by body posture, although the clinical relevance is uncertain. To enhance scapular upward rotation or posterior tilt, it may be preferable to place the patient in neutral sitting. LEVEL OF EVIDENCE Not applicable.
Collapse
Affiliation(s)
- Leanda McKenna
- School of Physiotherapy and Exercise Science, Curtin University of Technology, GPO Box U1987, Perth, Western Australia 6845(∗).
| | - Xavier Cornwall
- School of Physiotherapy and Exercise Science, Curtin University of Technology, Perth, Western Australia(†)
| | - Sian Williams
- School of Physiotherapy and Exercise Science, Curtin University of Technology, Perth, Western Australia(‡)
| |
Collapse
|
35
|
Ohlsson M, Nieto JH, Christe KL, Villablanca JP, Havton LA. Radiographic and Magnetic Resonance Imaging Identification of Thoracolumbar Spine Variants with Implications for the Positioning of the Conus Medullaris in Rhesus Macaques. Anat Rec (Hoboken) 2016; 300:300-308. [PMID: 27731939 DOI: 10.1002/ar.23495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/23/2015] [Indexed: 02/03/2023]
Abstract
The anatomy of the vertebral column in mammals may differ between species and between subjects of the same species, especially with regards to the composition of the thoracolumbar spine. We investigated, using several noninvasive imaging techniques, the thoracolumbar spine of a total of 44 adult rhesus macaques of both genders. Radiographic examination of the vertebral column showed a predominant spine phenotype with 12 rib-bearing thoracic vertebrae and 7 lumbar vertebrae without ribs in 82% of subjects, whereas a subset of subjects demonstrated 13 rib-bearing thoracic vertebrae and 6 lumbar vertebrae without ribs. Computer tomography studies of the thoraco-lumbar spine in two cases with a pair of supernumerary ribs showed facet joints between the most caudal pair of ribs and the associated vertebra, supporting a thoracic phenotype. Magnetic resonance imaging (MRI) studies were used to determine the relationship between the lumbosacral spinal cord and the vertebral column. The length of the conus medullaris portion of the spinal cord was 1.5 ± 0.3 vertebral units, and its rostral and caudal positions in the spinal canal were at 2.0 ± 0.3 and 3.6 ± 0.4 vertebral units below the thoracolumbar junction, respectively (n = 44). The presence of a set of supernumerary ribs did not affect the length or craniocaudal position of the conus medullaris, and subjects with13 rib-bearing vertebrae may from a functional or spine surgical perspective be considered as exhibiting12 thoracic vertebrae and an L1 vertebra with ribs. Anat Rec, 300:300-308, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Marcus Ohlsson
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Clinical Neuroscience, Divisions of Neurosurgery and Neuroradiology, Karolinska Institute, Stockholm, Sweden
| | - Jaime H Nieto
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kari L Christe
- California National Primate Research Center, UC Davis, Davis, California
| | - J Pablo Villablanca
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Leif A Havton
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California
| |
Collapse
|
36
|
Mieritz RM, Kawchuk GN. The Accuracy of Locating Lumbar Vertebrae When Using Palpation Versus Ultrasonography. J Manipulative Physiol Ther 2016; 39:387-392. [DOI: 10.1016/j.jmpt.2016.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/01/2016] [Accepted: 05/01/2016] [Indexed: 10/21/2022]
|
37
|
Snider KT, Johnson JC, Degenhardt BF, Snider EJ, Burton DC. Association of low back pain, somatic dysfunction, and lumbar bone mineral density: reproducibility of findings. J Osteopath Med 2016; 114:356-67. [PMID: 24778000 DOI: 10.7556/jaoa.2014.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Somatic dysfunction as diagnosed by palpation should be associated with an objective measure. Bone mineral density (BMD) has been shown to be elevated in lumbar vertebrae with somatic dysfunction and in the lumbar region of individuals with chronic low back pain (LBP). OBJECTIVE To investigate the association of lumbar somatic dysfunction and BMD T-score variability in participants with chronic LBP and without LBP (non-LBP) and to determine the reproducibility of previously published results. METHODS Two examiners, blinded to symptom history, evaluated participants for tissue texture abnormalities, rotational asymmetry, anterior motion restriction, and tenderness at vertebral levels L1 to L4. Participants also underwent dual-energy x-ray absorptiometry of vertebral levels L1 to L4 for the assessment of BMD T scores. Generalized linear models were used to compare the chronic LBP and non-LBP groups on the presence and severity of somatic dysfunction and to test whether group and the presence and severity of somatic dysfunction were related to BMD T scores. RESULTS Forty-three chronic LBP (54%) and 36 non-LBP participants (46%) completed the study. Although the presence of somatic dysfunction in the 2 groups was not significantly different, the presence of tenderness was significantly more common in the chronic LBP group (P<.001), as was the severity for tissue texture abnormalities (P=.03), motion restriction (P=.04), and tenderness (P<.001). Of the 316 vertebrae assessed, 31 (10%, all in the chronic LBP group) had moderate/severe tenderness. The vertebral somatic dysfunction burden score, the total somatic dysfunction burden score, the vertebral somatic dysfunction severity score, and the total somatic dysfunction severity score were higher in the chronic LBP group (all P<.001). The vertebral BMD T score was significantly higher for vertebrae demonstrating moderate/severe rotational asymmetry compared with those demonstrating mild or no rotational asymmetry (P=.01) and for vertebrae demonstrating moderate/severe tenderness compared with those demonstrating no tenderness (P=.04). CONCLUSION Study results suggest that somatic dysfunction was more significant in chronic LBP participants. Although the correlation between the presence of somatic dysfunction and segmental BMD T scores was not reproduced, BMD T scores were higher for vertebrae demonstrating moderate/severe rotational asymmetry and tenderness.
Collapse
Affiliation(s)
- Karen T Snider
- Department of Osteopathic Manipulative Medicine, A.T. Still University-Kirksville College of Osteopathic Medicine, 800 W Jefferson St, Kirksville, MO 63501-1443.
| | | | | | | | | |
Collapse
|
38
|
Comparative assessment of tactile sensitivity between undergraduate and postgraduate health sciences students. INT J OSTEOPATH MED 2016. [DOI: 10.1016/j.ijosm.2015.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
39
|
Lockwood MD, Kondrashova T, Johnson JC. Feasibility of Using Ultrasonography to Establish Relationships Among Sacral Base Position, Sacral Sulcus Depth, Body Mass Index, and Sex. J Osteopath Med 2015; 115:648-53. [PMID: 26501757 DOI: 10.7556/jaoa.2015.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Identifying relationships among anatomical structures is key in diagnosing somatic dysfunction. Ultrasonography can be used to visualize anatomical structures, identify sacroiliac landmarks, and validate anatomical findings and measurements in relation to somatic dysfunction. As part of the osteopathic manipulative medicine course at A.T. Still University-Kirksville College of Osteopathic Medicine, first-year students are trained to use ultrasonography to establish relationships among musculoskeletal structures. OBJECTIVES To determine the ability of first-year osteopathic medical students to establish sacral base position (SBP) and sacral sulcus depth (SSD) using ultrasonography and to identify the relationship of SBP and SSD to body mass index (BMI) and sex. METHODS Students used ultrasonography to obtain the distance between the skin and the sacral base (the SBP) and the distance between the skin and the tip of the posterior superior iliac spine bilaterally. Next, students calculated the SSD (the distance between the tip of the posterior superior iliac spine and the SBP). Data were analyzed with respect to side of the body, BMI, sex, and age. The BMI data were subdivided into normal (18-25 mg/kg) and overweight (25-30 mg/kg) groups. RESULTS Ultrasound images of 211 students were included in the study. The SBP was not significantly different between the left and right sides (36.5 mm vs 36.5 mm; P=.95) but was significantly different between normal and overweight BMI categories (33.0 mm vs 40.0 mm; P<.001) and between men and women (34.1 mm vs 39.0 mm; P<.001). The SSD was not significantly different between left and right sides (18.9 mm vs 19.8 mm; P=.08), normal and overweight BMI categories (18.9 mm vs 19.7 mm, P=.21), or men and women (19.7 mm vs 19.0 mm; P=.24). No significant relationship was identified between age and SBP (P=.46) or SSD (P=.39); however, the age range was narrow (21-33 years). CONCLUSION The study yielded repeatable and reproducible results when establishing SBP and SSD using ultrasonography. The statistically significant relationship between SBP and higher BMI and between SBP and female sex may point to more soft tissue overlaying the sacrum in these groups. Further research is needed on the use of ultrasonography to establish criteria for somatic dysfunction.
Collapse
|
40
|
Schmid S, Studer D, Hasler CC, Romkes J, Taylor WR, Brunner R, Lorenzetti S. Using Skin Markers for Spinal Curvature Quantification in Main Thoracic Adolescent Idiopathic Scoliosis: An Explorative Radiographic Study. PLoS One 2015; 10:e0135689. [PMID: 26270557 PMCID: PMC4535911 DOI: 10.1371/journal.pone.0135689] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/26/2015] [Indexed: 12/02/2022] Open
Abstract
Background and Purpose Although the relevance of understanding spinal kinematics during functional activities in patients with complex spinal deformities is undisputed among researchers and clinicians, evidence using skin marker-based motion capture systems is still limited to a handful of studies, mostly conducted on healthy subjects and using non-validated marker configurations. The current study therefore aimed to explore the validity of a previously developed enhanced trunk marker set for the static measurement of spinal curvature angles in patients with main thoracic adolescent idiopathic scoliosis. In addition, the impact of inaccurate marker placement on curvature angle calculation was investigated. Methods Ten patients (Cobb angle: 44.4±17.7 degrees) were equipped with radio-opaque markers on selected spinous processes and underwent a standard biplanar radiographic examination. Subsequently, radio-opaque markers were replaced with retro-reflective markers and the patients were measured statically using a Vicon motion capture system. Thoracolumbar / lumbar and thoracic curvature angles in the sagittal and frontal planes were calculated based on the centers of area of the vertebral bodies and radio-opaque markers as well as the three-dimensional position of the retro-reflective markers. To investigate curvature angle estimation accuracy, linear regression analyses among the respective parameters were used. The impact of inaccurate marker placement was explored using linear regression analyses among the radio-opaque marker- and spinous process-derived curvature angles. Results and Discussion The results demonstrate that curvatures angles in the sagittal plane can be measured with reasonable accuracy, whereas in the frontal plane, angles were systematically underestimated, mainly due to the positional and structural deformities of the scoliotic vertebrae. Inaccuracy of marker placement had a greater impact on thoracolumbar / lumbar than thoracic curvature angles. It is suggested that spinal curvature measurements are included in marker-based clinical gait analysis protocols in order to enable a deeper understanding of the biomechanical behavior of the healthy and pathological spine in dynamic situations as well as to comprehensively evaluate treatment effects.
Collapse
Affiliation(s)
- Stefan Schmid
- ETH Zurich, Institute for Biomechanics, Zurich, Switzerland
- Bern University of Applied Sciences, Health Division, Bern, Switzerland
- * E-mail:
| | - Daniel Studer
- University of Basel Children’s Hospital, Orthopaedic Department, Basel, Switzerland
| | | | - Jacqueline Romkes
- University of Basel Children’s Hospital, Laboratory for Movement Analysis, Basel, Switzerland
| | | | - Reinald Brunner
- University of Basel Children’s Hospital, Orthopaedic Department, Basel, Switzerland
- University of Basel Children’s Hospital, Laboratory for Movement Analysis, Basel, Switzerland
| | | |
Collapse
|
41
|
Bracht MA, Nunes GS, Celestino J, Schwertner DS, França LC, de Noronha M. Inter- and Intra-observer Agreement of the Motion Palpation Test for Lumbar Vertebral Rotational Asymmetry. Physiother Can 2015; 67:169-73. [PMID: 25931669 DOI: 10.3138/ptc.2014-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate inter- and intra-observer agreement in the assessment of lumbar vertebral rotational (VR) asymmetry by a motion palpation test. METHODS For this prospective and descriptive test-retest study, 51 asymptomatic participants (40 women, 11 men; mean age 23.3 [SD 5.6] years) were recruited from the community. Each participant was assessed in two sessions by the same three observers, who assessed VR by means of a palpatory test for movement asymmetry. This test is performed by applying posteroanterior pressure in an alternating manner to the left and right transverse processes of a vertebra to determine motion asymmetry in the transverse plane and thus the vertebral position. Observers classified the vertebral position as neutral, rotation to the right, and rotation to the left; they were blinded to which participant was being assessed and to any previous results. RESULTS Intra- and inter-observer agreement was verified by the kappa coefficient (κ) and the weighted kappa coefficient (κ w ). Values of κ and κ w varied from 0.07 (95% CI, -0.10 to 0.245) to 0.37 (95% CI, 0.11-0.63) for intra-observer agreement and from 0.12 (95% CI, -0.06 to 0.29) to 0.30 (95% CI, 0.08-0.52) for inter-observer agreement. CONCLUSION The motion palpation test used to assess VR asymmetry has low agreement levels; therefore, its clinical significance for measuring vertebral position is questionable.
Collapse
Affiliation(s)
- Marcelo Anderson Bracht
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Guilherme S Nunes
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Jardel Celestino
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Debora Soccal Schwertner
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Leandro Cardoso França
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Marcos de Noronha
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil ; Department of Allied Health, La Trobe University, Bendigo, VIC, Australia
| |
Collapse
|
42
|
Validation of Palpatory Methods for Evaluating Anatomical Bone Landmarks of the Cervical Spine: A Systematic Review. J Manipulative Physiol Ther 2015; 38:302-10. [DOI: 10.1016/j.jmpt.2015.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 01/07/2015] [Accepted: 02/18/2015] [Indexed: 11/22/2022]
|
43
|
Cooperstein R, Haneline M, Young M. The location of the inferior angle of the scapula in relation to the spine in the upright position: a systematic review of the literature and meta-analysis. Chiropr Man Therap 2015; 23:7. [PMID: 25729566 PMCID: PMC4343265 DOI: 10.1186/s12998-014-0050-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/26/2014] [Indexed: 11/12/2022] Open
Abstract
Practitioners in several of the health care professions use anatomical landmarks to identify spinal levels, both in order to enhance diagnostic accuracy and to specifically target the site of intervention. Authoritative sources usually state the upright inferior scapular angle (IAS) aligns with the spinous process (SP) of T7, but some specify the T7-8 interspace or the T8 SP. The primary goals of this study were to systematically review the relevant literature; and conduct a meta-analysis of the pooled data from retrieved studies to increase their statistical power. Electronic searching retrieved primary studies relating the IAS to a spinal level, as determined by an imaging reference standard, using combinations of these search terms: scapula, location, landmark, spinous process, thoracic vertebrae, vertebral level, palpation, and spine. Only primary studies were included; review articles and reliability studies related to scapular position but lacking spinal correlations were excluded. Eight-hundred and eighty (880) articles of interest were identified, 43 abstracts were read, 22 full text articles were inspected, and 5 survived the final cut. Each article (with one exception) was rated for quality using the QUADAS instrument. Pooling data from 5 studies resulted in normal distribution in which the upright IAS on average aligns closely with the T8 SP, range T4-T11. Since on average the IAS most closely identifies the T8 SP in the upright position, it is very likely that health professionals, both manual therapists and others, who have been diagnosing and treating patients based on the IAS = T7 SP rule (the conventional wisdom), have not been as segmentally accurate as they may have supposed. They either addressed non-intended levels, or made numeration errors in their charting. There is evidence that using the IAS is less preferred than using the vertebra prominens, and may be less preferred than using the iliac crest for identifying spinal levels Manual therapists, acupuncturists, anesthesiologists, nurses, and surgeons should reconsider their procedures for identifying spinal sites in light of this modified information. Inaccurate landmark benchmark rules will add to patient variation and examiner errors in producing spine care targeting errors, and confound research on the importance of specificity in treating spinal levels.
Collapse
Affiliation(s)
- Robert Cooperstein
- Palmer West College of Chiropractic, 90 East Tasman Drive, San Jose, CA 94577 USA
| | - Michael Haneline
- University of Western States, 2900 NE 132nd Avenue, Portland, OR 97230 USA
| | - Morgan Young
- Palmer West College of Chiropractic, 90 East Tasman Drive, San Jose, CA 94577 USA
| |
Collapse
|
44
|
Poredoš P, Čelan D, Možina J, Jezeršek M. Determination of the human spine curve based on laser triangulation. BMC Med Imaging 2015; 15:2. [PMID: 25651841 PMCID: PMC4327951 DOI: 10.1186/s12880-015-0044-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/21/2015] [Indexed: 12/04/2022] Open
Abstract
Background The main objective of the present method was to automatically obtain a spatial curve of the thoracic and lumbar spine based on a 3D shape measurement of a human torso with developed scoliosis. Manual determination of the spine curve, which was based on palpation of the thoracic and lumbar spinous processes, was found to be an appropriate way to validate the method. Therefore a new, noninvasive, optical 3D method for human torso evaluation in medical practice is introduced. Methods Twenty-four patients with confirmed clinical diagnosis of scoliosis were scanned using a specially developed 3D laser profilometer. The measuring principle of the system is based on laser triangulation with one-laser-plane illumination. The measurement took approximately 10 seconds at 700 mm of the longitudinal translation along the back. The single point measurement accuracy was 0.1 mm. Computer analysis of the measured surface returned two 3D curves. The first curve was determined by manual marking (manual curve), and the second was determined by detecting surface curvature extremes (automatic curve). The manual and automatic curve comparison was given as the root mean square deviation (RMSD) for each patient. The intra-operator study involved assessing 20 successive measurements of the same person, and the inter-operator study involved assessing measurements from 8 operators. Results The results obtained for the 24 patients showed that the typical RMSD between the manual and automatic curve was 5.0 mm in the frontal plane and 1.0 mm in the sagittal plane, which is a good result compared with palpatory accuracy (9.8 mm). The intra-operator repeatability of the presented method in the frontal and sagittal planes was 0.45 mm and 0.06 mm, respectively. The inter-operator repeatability assessment shows that that the presented method is invariant to the operator of the computer program with the presented method. Conclusions The main novelty of the presented paper is the development of a new, non-contact method that provides a quick, precise and non-invasive way to determine the spatial spine curve for patients with developed scoliosis and the validation of the presented method using the palpation of the spinous processes, where no harmful ionizing radiation is present.
Collapse
Affiliation(s)
- Primož Poredoš
- University of Ljubljana, Faculty of Mechanical Engineering, Aškerčeva 6, 1000, Ljubljana, Slovenia.
| | - Dušan Čelan
- University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia.
| | - Janez Možina
- University of Ljubljana, Faculty of Mechanical Engineering, Aškerčeva 6, 1000, Ljubljana, Slovenia.
| | - Matija Jezeršek
- University of Ljubljana, Faculty of Mechanical Engineering, Aškerčeva 6, 1000, Ljubljana, Slovenia.
| |
Collapse
|
45
|
Lin N, Li Y, Bebawy JF, Dong J, Hua L. Abdominal circumference but not the degree of lumbar flexion affects the accuracy of lumbar interspace identification by Tuffier's line palpation method: an observational study. BMC Anesthesiol 2015; 15:9. [PMID: 25670920 PMCID: PMC4323173 DOI: 10.1186/1471-2253-15-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/15/2015] [Indexed: 11/25/2022] Open
Abstract
Background Lumbar puncture for spinal or epidural anesthesia is commonly performed by palpating bony landmarks, but identification of the desired intervertebral level is often inaccurate. It is unclear whether such inaccuracy is related to patient factors, such as body mass index and degree of lumbar flexion. We hypothesized that overweight patients and patients with less of an ability to hyperflex their lumbar spines are prone to inaccurate lumbar spinous intervertebral level identification. Methods 52 adult volunteers were included in this study. 7 anesthesiologists with different years of experience identified and marked subjects’ levels of the iliac crests, then marked the presumed interspaces. Lumbar X-ray was then performed with metal markers, and actual radiographic findings were identified and compared to the initial markings. Results Patients with larger abdominal circumferences (mean (SD), 94.0(12.1) cm), higher body mass indices (25.9(3.9) kg/m2), and aged between 50 and 70 years old had lumbar interspaces that were higher than the presumed level; patients with smaller abdominal circumferences (82.8(13.5) cm) and lower body mass indices (21.6(4.1) kg/m2) had intervertebral levels that were lower than the presumed level. Cobb’s angle, indicating the degree of lumbar flexion, did not affect the accuracy obtained. Conclusions Patients’ abdominal circumference, body mass index, and age are factors that may impact the accuracy of lumbar level identification. Tuffier’s line, as identified by palpation, does not seem to be a reliable landmark for proper lumbar interspace identification in all cases.
Collapse
Affiliation(s)
- Nan Lin
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 P.R. China
| | - Yan Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 P.R. China
| | - John F Bebawy
- Northwestern University Feinberg School of Medicine, 251 E. Huron St., Suite F5-704, Chicago, IL 60611 USA
| | - Jia Dong
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 P.R. China
| | - Lin Hua
- Biomedical Engineering Institute of Capital Medical University, Beijing, 100069 China
| |
Collapse
|
46
|
Loh MS, Gevitz N, Gilliar WG, Iacono LM, Jung MK, Krishnamachari B, Amsler K. Use of a novel assay to measure pre- to posttraining palpatory skills of first-year osteopathic medical students. J Osteopath Med 2015; 115:32-40. [PMID: 25550490 DOI: 10.7556/jaoa.2015.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Although palpation is a central skill in the practice of osteopathic medicine, few data are available on factors affecting the development of palpatory skills. OBJECTIVE To use a novel palpatory skills assay to assess the role of training and practice in the development of palpatory skills in an osteopathic medical student population. METHODS The palpatory skills of first-year osteopathic medical students were assessed using a simple, objective palpation assay that consisted of locating a dime placed under sheets of copy paper at depths of 50, 100, 150, 200, 300, and 400 sheets. Two trials were performed at each depth. The assay was performed at the beginning and at the end of the students' first term. To determine whether practice with the assay impacted participant performance, a third assay was conducted to compare the performance of students who completed the assays at the beginning and at the end of the term with that of students who had never completed the assay. RESULTS Sixty-three participants completed the assays at the beginning and end of the term. Fifty-seven of those 63 participants and 192 participants who had not previously completed the assay completed the third assay. A wide variability in number of correct responses per participant was observed at both the beginning (range, 0-11 correct) and the end (range, 2-12 correct) of the term. The mean (SD) number of correct responses per participant increased from the beginning (5.49 [2.78]) to the end (7.17 [2.27]) of the term. Analysis using the generalized estimating equation model demonstrated that both paper depth and experience (ie, beginning vs end of the term) were statistically significant determinants of the number of correct responses (P<.001). The Kaplan-Meier method indicated that the median paper depth at which participants first scored no correct responses increased from 200 sheets (95% CI, 171-229) at the beginning of the term to 300 sheets (95% CI, 232-367) at the end of the term (P<.001). In the third assay, no significant differences were noted in the performance of students who had completed the 2 previous assays vs participants who had not completed the previous assays (P=.136). CONCLUSION Participants' palpatory skills improved from the beginning to the end of the term. The range of participants' palpatory skills at the beginning of the term suggests that other factors in addition to training influenced participants' palpatory skill level. Additional research is needed to identify and investigate factors that influence the development of palpatory skills.
Collapse
Affiliation(s)
- Meredith S Loh
- From the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) in Old Westbury (Student Doctors Loh and Iacono and Drs Gilliar, Jung, Krishnamachari, and Amsler) and the A.T. Still University-Kirskville College of Osteopathic Medicine in Missouri (Dr Gevitz)
| | - Norman Gevitz
- From the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) in Old Westbury (Student Doctors Loh and Iacono and Drs Gilliar, Jung, Krishnamachari, and Amsler) and the A.T. Still University-Kirskville College of Osteopathic Medicine in Missouri (Dr Gevitz)
| | - Wolfgang G Gilliar
- From the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) in Old Westbury (Student Doctors Loh and Iacono and Drs Gilliar, Jung, Krishnamachari, and Amsler) and the A.T. Still University-Kirskville College of Osteopathic Medicine in Missouri (Dr Gevitz)
| | - Lauren M Iacono
- From the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) in Old Westbury (Student Doctors Loh and Iacono and Drs Gilliar, Jung, Krishnamachari, and Amsler) and the A.T. Still University-Kirskville College of Osteopathic Medicine in Missouri (Dr Gevitz)
| | - Min-Kyung Jung
- From the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) in Old Westbury (Student Doctors Loh and Iacono and Drs Gilliar, Jung, Krishnamachari, and Amsler) and the A.T. Still University-Kirskville College of Osteopathic Medicine in Missouri (Dr Gevitz)
| | - Bhuma Krishnamachari
- From the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) in Old Westbury (Student Doctors Loh and Iacono and Drs Gilliar, Jung, Krishnamachari, and Amsler) and the A.T. Still University-Kirskville College of Osteopathic Medicine in Missouri (Dr Gevitz)
| | - Kurt Amsler
- From the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) in Old Westbury (Student Doctors Loh and Iacono and Drs Gilliar, Jung, Krishnamachari, and Amsler) and the A.T. Still University-Kirskville College of Osteopathic Medicine in Missouri (Dr Gevitz)
| |
Collapse
|
47
|
VanderWielen BA, Harris R, Galgon RE, VanderWielen LM, Schroeder KM. Teaching sonoanatomy to anesthesia faculty and residents: utility of hands-on gel phantom and instructional video training models. J Clin Anesth 2014; 27:188-94. [PMID: 25433727 DOI: 10.1016/j.jclinane.2014.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/05/2014] [Accepted: 07/10/2014] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE Thousands of patients worldwide annually receive neuraxial anesthesia and analgesia. Obesity, pregnancy, and abnormal spinal anatomy pose challenges for accurate landmark palpation. Further, spinal sonoanatomy is not uniformly taught in residency education, even though its use has previously been shown to improve identification of relevant structures and decrease procedural complications and failure rates. The aim of this study was to evaluate the use of hands-on gel phantom and instructional video training for teaching spinal sonoanatomy among anesthesiology faculty and residents. DESIGN Twenty-three residents and 27 anesthesiologists were randomized to gel phantom, video teaching, and control groups. SETTING Academic Hospital. MEASUREMENTS Successful identification of spinal sonoanatomy was attempted on a human volunteer before and immediately after the respective intervention and 3 weeks later. Perceived knowledge and training modality satisfaction were assessed using modified Likert scales. INTERVENTIONS Gel phantom and video teaching groups compared with control (no intervention). MAIN RESULTS Both interventions significantly improved spine sonoanatomy identification accuracy. Logistic regression analysis demonstrated both interventions improved the odds of transverse process (gel 12.61, P = .013; video 7.93, P = .030) and lamina (gel 65.12, P = .003; video 8.97, P = .031) identification. Perceived knowledge of basic spinal anatomy and spinal sonoanatomy improved in the intervention versus control groups. Mean (SD) modified Likert scale scores for learning satisfaction (1 = unsatisfied, 10= very satisfied) were 8.1 (1.5) and 8.0 (1.7) for hands-on gel phantom and instructional video training participants, respectively. CONCLUSION Use of hands-on gel phantom or instructional video training can improve anesthesia staff and resident knowledge of lumbar spine sonoanatomy.
Collapse
Affiliation(s)
- Beth A VanderWielen
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
| | - Ronen Harris
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Richard E Galgon
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lynn M VanderWielen
- Department of Health Administration, Virginia Commonwealth University, Richmond, VA, USA
| | - Kristopher M Schroeder
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| |
Collapse
|
48
|
Snider EJ, Pamperin K, Johnson JC, Shurtz NR, Degenhardt BF. Assessing palpation thresholds of osteopathic medical students using static models of the lumbar spine. J Osteopath Med 2014; 114:460-9. [PMID: 24917633 DOI: 10.7556/jaoa.2014.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Although spinal somatic dysfunction diagnosis is taught at all colleges of osteopathic medicine, few objective measures have been used to evaluate student accuracy. OBJECTIVE To assess the palpatory skills of osteopathic medical students in evaluating positional asymmetry in the transverse plane using static block transverse process and lumbar spine models. METHODS For this observational study, first-year osteopathic medical students completed 3 palpatory assessments using uncovered and covered block transverse process and lumbar spine models to simulate a range of positional asymmetries of the transverse processes. With use of logistic regression, 80%, 90%, and 95% thresholds were defined as the magnitude of asymmetry for which the predicted probability of students correctly determining the direction of asymmetry exceeded a specified amount (.80, .90, or .95). RESULTS A total of 346 students completed the assessments. For the uncovered block transverse process model (assessment 1), students correctly identified the direction of asymmetry with .89 probability at 1 mm of asymmetry (80% threshold), .94 probability at 2 mm (90% threshold), and .95 probability at 3 mm (95% threshold). For the covered block transverse process model, students correctly identified the direction of asymmetry with .80 probability at 1 mm (80% threshold), .92 probability at 2 mm (90% threshold), and .98 probability at 3 mm (95% threshold) by the third assessment. For the uncovered lumbar spine model (assessment 2), students correctly identified the direction of asymmetry with .93 probability at 2 mm (80% and 90% thresholds) and .95 probability at 3 mm (95% threshold). For the covered lumbar spine model (assessments 2 and 3), students correctly identified the direction of asymmetry with .87 probability at 4 mm (80% threshold); 90% and 95% thresholds were not reached with the range of asymmetries tested. CONCLUSION Most first-year osteopathic medical students were able to discern the direction of positional asymmetry of transverse processes on static models. Depending on the model type, student performance improved (block transverse process models) or declined (lumbar spine models) over time. Future studies should evaluate whether accuracy of palpating lumbar spine models translates to accuracy of palpating human lumbar spines.
Collapse
Affiliation(s)
- Eric J Snider
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
| | - Kenneth Pamperin
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
| | - Jane C Johnson
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
| | - Natalie R Shurtz
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
| | - Brian F Degenhardt
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
| |
Collapse
|
49
|
CHENG SUCHUN, HSIAO CHIHKUN, TSOU JUIYI, LIN RUEYMO, SU FONGCHIN. PREDICTING THE VERTEBRAL BODY POSITION BASED ON PALPATED SPINOUS PROCESS POSITION. J MECH MED BIOL 2014. [DOI: 10.1142/s0219519414500109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Palpation is an essential skill of manual therapy. Clinical techniques of physical therapy usually assume that the movement direction of palpating spinous process (SP) is the direction of the vertebral body center (VBC). This study investigated the distance [SP–projected VBC (PVBC)] between the surface palpation of the five SPs and the radiographically projected vertebral center locations (PVBC) on the skin of the lumbar spine in 37 patients with low back pain (LBP). The measurement of SP–PVBC was intended to describe if palpation on SPs could explain the positions of the VBC. The SP–PVBC distance was the greatest at L1 (35.9 mm) and the smallest at L4 (15.1 mm). The predictive analysis investigated the relationships between SP–PVBC and the geometric measurements of the lumbar anatomical structures. The geometric characteristics of the lumbar spine affected the SP–PVBC distance in different levels, with the R2 values from 0.66–0.89, except 0.38 in the L4 level. Increases in the SP inclination as well as vertebral inclinations, and increases in the SP height (SPH) were factors that were found to be significantly related to the SP–PVBC distance (p < 0.05). The results indicate that the orientation of the VBC and the SP may not be the same, and tilting and rotation of the vertebrae may occur when applying manual techniques through SPs. Physical therapists need to be aware that the tilting or rolling effect of vertebrae may not be avoidable once the treatment is done via palpation on SPs.
Collapse
Affiliation(s)
- SU-CHUN CHENG
- Department of Biomedical Engineering, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan
- Department of Physical Therapy, Fooyin University, 151 Jinxue Road, Kaohsiung City 83102, Taiwan
| | - CHIH-KUN HSIAO
- Biomechanics Laboratory, Department of Orthopedics, E-Da Hospital, 1 Yi-Da Road, Kaohsiung County, Taiwan
| | - JUI-YI TSOU
- Department of Physical Therapy, Fooyin University, 151 Jinxue Road, Kaohsiung City 83102, Taiwan
| | - RUEY-MO LIN
- Department of Orthopedics, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan
| | - FONG-CHIN SU
- Department of Biomedical Engineering, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan
| |
Collapse
|
50
|
Snider KT, Johnson JC, Degenhardt BF, Snider EJ. The persistence of lumbar somatic dysfunction and its association with bone mineral density. J Osteopath Med 2014; 114:8-20. [PMID: 24384969 DOI: 10.7556/jaoa.2014.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Clinically meaningful somatic dysfunction, if left untreated, should persist over time and be associated with objective measurable findings. OBJECTIVE To investigate the persistence of lumbar somatic dysfunction over 8 weeks and the association of that persistence with lumbar bone mineral density (BMD) T scores. METHODS Individuals were assessed at 0, 4, and 8 weeks for the presence and severity of paraspinal tissue texture abnormalities (TTA), vertebral rotational asymmetry, anterior motion restriction, and tenderness from L1 to L4. Participants underwent dual-energy x-ray absorptiometry of the lumbar spine at 0 and 8 weeks. Persistent somatic dysfunction findings from all 3 examinations were compared with BMD T scores obtained at 8 weeks and to changes in the BMD T scores from 0 to 8 weeks. RESULTS Forty-eight individuals (38 women [79%] and 10 men [21%]) participated in the study. The mean (standard deviation [SD]) age was 30.1 (6.4) years (range, 20.0-40.8 years), and the mean (SD) body mass index was 26.3 (5.2). The percentage of vertebrae with persistent somatic dysfunction varied by vertebral level and ranged from 44% to 83% for TTA, 63% to 79% for rotational asymmetry, 10% to 56% for motion restriction, and 2% to 10% for tenderness. Vertebral segments with persistent motion restriction had higher mean BMD T scores (95% confidence interval [CI]) than those without persistent motion restriction (0.6 [0.4 to 0.8] vs 0.2 [0.1 to 0.4], respectively; P=.02). There was a significant increase in the vertebral BMD T scores for those vertebrae that demonstrated persistent TTA (P=.02) and for those vertebrae that demonstrated persistent moderate/severe TTA (P=.02). A significant difference was found in the initial to final vertebral BMD T-score change between vertebrae that demonstrated persistent tenderness and those that did not (mean [95% CI] change, -0.2 [-0.4 to 0.1] vs 0.1 [0.0 to 0.1], respectively; P=.04). CONCLUSION A persistence of predominantly left lumbar rotation was observed. Persistent vertebral motion restriction was shown to have an association with final lumbar BMD T scores, and persistent TTA and tenderness were associated with changes in the BMD T scores over 8 weeks.
Collapse
Affiliation(s)
- Karen T Snider
- Department of Osteopathic Manipulative Medicine, A.T. Still University-Kirksville College of Osteopathic Medicine, 800 W Jefferson St, Kirksville, MO 63501-1443.
| | | | | | | |
Collapse
|