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Hvidkær IS, Harsted S, Hadizadeh M, O’Neill S, Kawchuk GN, Nim C. Static palpation ain't easy: Evaluating palpation precision using a topographical map of the lumbar spine as a reference. PLoS One 2024; 19:e0304571. [PMID: 38814967 PMCID: PMC11139336 DOI: 10.1371/journal.pone.0304571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/10/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Clinicians commonly use manual therapy to treat low back pain by palpating the spine to identify the spinous processes. This study aims to evaluate the ability of experienced clinicians to consistently locate the spinous processes from S1 to T12 through palpation. The results will be compared to topographical data representing the lumbar lordosis at baseline and four follow-up time points. MATERIALS AND METHODS In a prior prospective randomized trial, experienced clinicians used palpation to locate the lumbar spinous processes (S1-T12) and then digitized these locations in three-dimensional space. The same digitizing equipment was then used to continuously collect three-dimensional position data of a wheel that rolled along the back's surface through a trajectory that connected the previously digitized locations of the spinous processes. This process was repeated at 4 days, 1, 4, and 12 weeks. The resulting lordosis trajectories were plotted and aligned using the most anterior point in the lordosis to compare the locations of the spinous processes identified in different trials. This way, spinous palpation points could be compared to surface topography over time. Intra- and interrater reliability and agreement were estimated using intraclass correlations of agreement and Bland-Altman limits of agreement. RESULTS Five clinicians palpated a total of 119 participants. The results showed a large degree of variation in precision estimates, with a mean total value of 13 mm (95%CI = 11;15). This precision error was consistent across all time points. The smallest precision error was found at L5, followed by S1 File, after which the error increased superiorly. Intra- and interrater reliability was poor to moderate. CONCLUSIONS Comparison of palpation results to a topographic standard representing the lumbar lordosis is a new approach for evaluating palpation. Our results confirm the results of prior studies that find palpation of lumbar spinous processes imprecise, even for experienced clinicians.
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Affiliation(s)
- Inge Strøh Hvidkær
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark
| | - Steen Harsted
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Søren O’Neill
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Gregory Neil Kawchuk
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Casper Nim
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Yelverton C, Zipfel B, Williams S, Peterson C. The frequency and presentation of upper thoracic spinous process deviations, their relationship to articular morphology, and the potential influence on static palpation techniques. J Bodyw Mov Ther 2024; 37:1-10. [PMID: 38432788 DOI: 10.1016/j.jbmt.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/07/2023] [Accepted: 09/29/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Static palpation of vertebral spinous process deviations from the midline are often utilized by manual therapists as a means to determine area for treatment of manipulable lesions. Previous research has discussed the diagnostic validity of this technique, but no correlation to vertebral morphology has been presented. AIM To evaluate the frequency and presentation of vertebral spinous process deviations and their relationship with articular morphology, and the impact this may have in terms of static palpation techniques in the upper thoracic spine. SETTING This study was conducted on human T1-T6 vertebrae. METHOD A skeletal sample consisting of 58 humans T1-T6 vertebrae were photographed and linear and angular measurements taken utilizing ImageJ software and non-metric visual observations. RESULTS Spinous process deviations in the entire sample group (n = 348) were found to occur in a frequency ranging from 19% (n = 11) at T1 to 41.4% (n = 24) at T3. However, when evaluated in terms of frequency within an individual's T1-T6, 83.3% (n = 25) of males and 67.86% (n = 19) of females demonstrated this feature, with an overall incidence of 77.59% (n = 45). Age of individuals did not show an increase in frequency, and no clear pattern could be identified regarding metric measurements and its presence. CONCLUSION Spinous process deviations in the upper thoracic spine are most probably the result of random normal variations between individuals and are more frequent in males. Static palpation without pain criteria is not a reliable diagnostic technique to determine areas needing manual treatment, as these may be considered normal osseous anatomical variations.
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Affiliation(s)
- Christopher Yelverton
- Department of Chiropractic, University of Johannesburg, John Orr Building, 7th Floor, 55 Beit Street, Doornfontein, Johannesburg, 2028, South Africa.
| | - Bernhard Zipfel
- Evolutionary Studies Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Scott Williams
- Evolutionary Studies Institute, University of Witwatersrand, Johannesburg, South Africa; Center for the Study of Human Origins, Department of Anthropology, New York University, New York, USA
| | - Cynthia Peterson
- Department of Chiropractic, University of Johannesburg, John Orr Building, 7th Floor, 55 Beit Street, Doornfontein, Johannesburg, 2028, South Africa
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Mine K, Ono K, Tanpo N. The reliability of palpatory examinations for pelvic landmarks to determine pelvic asymmetry: a systematic review and meta-analysis. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.2019368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Koya Mine
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Kenta Ono
- Department of Rehabilitation, Kuwano Kyoritsu Hospital, Fukushima, Japan
| | - Nobuhito Tanpo
- Department of Rehabilitation, Takeda General Hospital, Fukushima, Japan
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Nolet PS, Yu H, Côté P, Meyer AL, Kristman VL, Sutton D, Murnaghan K, Lemeunier N. Reliability and validity of manual palpation for the assessment of patients with low back pain: a systematic and critical review. Chiropr Man Therap 2021; 29:33. [PMID: 34446040 PMCID: PMC8390263 DOI: 10.1186/s12998-021-00384-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/22/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Static or motion manual palpation of the low back is commonly used to assess pain location and reproduction in low back pain (LBP) patients. The purpose of this study is to review the reliability and validity of manual palpation used for the assessment of LBP in adults. METHOD We systematically searched five databases from 2000 to 2019. We critically appraised internal validity of studies using QAREL and QUADAS-2 instruments. We stratified results using best-evidence synthesis. Validity studies were classified according to Sackett and Haynes. RESULTS We identified 2023 eligible articles, of which 14 were low risk of bias. Evidence suggests that reliability of soft tissue structures palpation is inconsistent, and reliability of bony structures and joint mobility palpation is poor. We found preliminary evidence that gluteal muscle palpation for tenderness may be valid in differentiating LBP patients with and without radiculopathy. CONCLUSION Reliability of manual palpation tests in the assessment of LBP patients varies greatly. This is problematic because these tests are commonly used by manual therapists and clinicians. Little is known about the validity of these tests; therefore, their clinical utility is uncertain. High quality validity studies are needed to inform the clinical use of manual palpation tests.
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Affiliation(s)
- Paul S. Nolet
- Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario Canada
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario Canada
- CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6211 LM Maastricht, The Netherlands
| | - Hainan Yu
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario Canada
- Canadian Memorial Chiropractic College, Toronto, Ontario Canada
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario Canada
| | | | - Vicki L. Kristman
- EPID@Work Research Institute, Department of Health Sciences, and the Division of Human Sciences, Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ontario Canada
- Institute for Work and Health, Toronto, Ontario Canada
| | - Deborah Sutton
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario Canada
| | - Kent Murnaghan
- Canadian Memorial Chiropractic College, Toronto, Ontario Canada
| | - Nadège Lemeunier
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario Canada
- UMR1295, Université de Toulouse, UPS, Inserm, Toulouse, France
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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]
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Reichert B. Bestimmung einer Beckenasymmetrie – Sinn oder Unsinn. MANUELLE MEDIZIN 2021. [DOI: 10.1007/s00337-020-00703-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungPathologien des tiefen Rückens, der Becken- sowie Knie- und Hüftgelenke werden immer wieder mit einer Messung der Beinlänge und Feststellung einer Beckenasymmetrie in Verbindung gebracht. Aufgrund dieser Messungen werden therapeutische Wege eingeschlagen. Zu diesem Thema wurden auf der Basis einer systematischen Literatursuche in zwei maßgeblichen Datenbanken 28 Artikel ermittelt. Die inhaltliche Analyse beschäftigt sich v. a. mit der Variationsanatomie des Beckens sowie der Reliabilität palpatorischer und apparativer Bestimmungen von knöchernen Referenzpunkten am Becken. Hieraus ergeben sich maßgebliche Erkenntnisse: Eine Variationsanatomie des Beckens ist häufig und kommt auch bei nichtsymptomatischen Personen vor. Die palpatorische und apparative Bestimmungen der knöchernen Referenzpunkte sind gering bis moderat reliabel. Der Rückschluss von einer festgestellten Beckenasymmetrie auf den Einfluss bestehender oder noch zu erwartender Rücken‑, Hüft- oder Beckengelenkbeschwerden ist nach derzeitiger Studienlage zumindest umstritten und daher nicht empfehlenswert.
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Beales D, Slater H, Palsson T, O'Sullivan P. Understanding and managing pelvic girdle pain from a person-centred biopsychosocial perspective. Musculoskelet Sci Pract 2020; 48:102152. [PMID: 32560860 DOI: 10.1016/j.msksp.2020.102152] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/08/2019] [Accepted: 03/10/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Clinicians need support to effectively implement a biopsychosocial approach to people with pelvic girdle pain disorders. PURPOSE A practical clinical framework aligned with a contemporary biopsychosocial approach is provided to help guide clinician's management of pelvic girdle pain. This approach is consistent with current pain science which helps to explain potential mechanistic links with co/multi-morbid conditions related to pelvic girdle pain. Further, this approach also aligns with the Common-Sense Model of Illness and provides insight into how an individual's illness perceptions can influence their emotional and behavioural response to their pain disorder. Communication is critical to supporting recovery and facilitating behaviour change within the biopsychosocial context and in this context, the patient interview is central to exploring the multidimensional nature of a persons' presentation. Focusing the biopsychosocial framework on targeted cognitive-functional therapy as a key component of care can help an individual with pelvic girdle pain make sense of their pain, build confidence and self-efficacy and facilitate positive behaviour and lifestyle change. There is growing evidence of the efficacy for this broader integrative approach, although large scale effectiveness trials are still needed. An in-depth case study provides guidance for clinicians, showing 'how to' implement these concepts into their own practice within a coherent practical framework. IMPLICATIONS This framework can give clinicians more confidence in understanding and managing pelvic girdle pain. The framework provides practical strategies to assist clinicians with implementation; assisting the transition from knowing to doing in an evidence-informed manner that resonates with real world practice.
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Affiliation(s)
- Darren Beales
- School of Physiotherapy and Exercise Science, Curtin University of Technology, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University of Technology, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Thorvaldur Palsson
- Department of Health Science and Technology, SMI®, Faculty of Medicine, Aalborg University, 9220, Aalborg, Denmark
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University of Technology, GPO Box U1987, Perth, Western Australia, 6845, Australia
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Bergna A, Vismara L, Parravicini G, Dal Farra F. A new perspective for Somatic Dysfunction in Osteopathy: the Variability Model. J Bodyw Mov Ther 2020; 24:181-189. [DOI: 10.1016/j.jbmt.2020.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 11/19/2019] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
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Determination of the Prevalence From Clinical Diagnosis of Sacroiliac Joint Dysfunction in Patients With Lumbar Disc Hernia and an Evaluation of the Effect of This Combination on Pain and Quality of Life. Spine (Phila Pa 1976) 2020; 45:549-554. [PMID: 31842104 PMCID: PMC7208275 DOI: 10.1097/brs.0000000000003309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cross-sectional study. OBJECTIVE To evaluate the prevalence of sacroiliac joint dysfunction in patients with lumbar disc hernia and examine the variations in clinical parameters cause by this combination. SUMMARY OF BACKGROUND DATA Although one of the many agents leading to lumbar pain is sacroiliac dysfunction, little progress has still been made to evaluate mechanical pain from sacroiliac joint dysfunction within the context of differential diagnosis of lumbar pain. METHODS Two hundred thirty-four patients already diagnosed with lumbar disc hernia were included in the study. During the evaluation, sacroiliac joint dysfunction was investigated using specific tests, pain levels with a Visual Analog Scale, and the presence of neuropathic pain using Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Other clinical assessments were performed using the Beck Depression Inventory, Health Assessment Questionnaire, and Tampa Kinesiophobia Scale. RESULTS 63.2% of patients were female and 36.8% were male. Mean age was 46.72 ± 11.14 years. The level of sacroiliac joint dysfunction was 33.3% in the research population. In terms of sex distribution, the proportion of women was higher in the group with sacroiliac joint dysfunction (P < 0.05). No significant difference was observed in pain intensity assessed using a Visual Pain Scale between the groups (P > 0.05), but the level of neuropathic pain was significantly higher in the group with dysfunction (P < 0.05). In the group with sacroiliac joint dysfunction, the presence of depression was significantly higher (P = 0.009), functional capacity was worse (P < 0.001), and the presence of kinesophobia was higher (P = 0.02). CONCLUSION Our study results will be useful in attracting the attention of clinicians away from the intervertebral disc to the sacroiliac joint in order to avoid unnecessary and aggressive treatments. LEVEL OF EVIDENCE 2.
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Lee AS, Pyle CW, Redding D. Accuracy of Anterior Superior Iliac Spine Symmetry Assessment by Routine Structural Examination. J Osteopath Med 2015. [DOI: 10.7556/jaoa.2015.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Context: Assessment of the anterior superior iliac spine (ASIS) is a key component in generating the pelvic diagnosis of somatic dysfunction, but studies have shown poor reliability between examiners.
Objective: To assess the influence of homogeneous training, years of experience, and eye dominance on the percentage of correctness, sensitivity, and specificity of ASIS evaluation.
Methods: Osteopathic physicians, predoctoral teaching fellows, and first- and second-year osteopathic medical students from a single teaching institute assessed 3 plastic pelvic models with ASIS anatomic landmarks set at different levels: even and 5- and 10-mm descrepancies. Dominant and nondominant eyes were used independently to assess ASIS levels.
Results: A total of 147 examiners (participants) participated in this study (66 first-year and 61 second-year medical students, 15 fellows, and 5 osteopathic physicians). The overall percentages of correct results were 31.0% (even levels), 82.8% (5-mm discrepancy), and 91.7% (10-mm discrepancy). Differences by level of training were statistically significant only for the 5-mm ASIS discrepancy, where participants with more experience performed better. The overall sensitivity was 82.8% (5-mm discrepancy) and 91.7% (10-mm discrepancy), and the specificity was 31.0%. No statistically significant differences were found in the percentage of correct results by eye dominance.
Conclusion: Assessment of ASIS is sensitive but not specific at discrepancies of 5 mm or greater. Length of experience positively influences the percentage of correct results, and eye dominance does not significantly change this outcome. This form of assessment can be used to screen for ASIS asymmetry.
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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.
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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
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Sabini RC, Leo CS, Moore AE. The relation of experience in osteopathic palpation and object identification. Chiropr Man Therap 2013; 21:38. [PMID: 24499607 PMCID: PMC3843593 DOI: 10.1186/2045-709x-21-38] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 11/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine whether osteopathic medical students, fellows, residents, and practicing physicians differ in their ability to identify inanimate objects and if these skills relate to palpatory experience. METHODS Fifteen commonly known objects were fixed to a board and blinded with a cotton cloth. In Part I of testing, participants were asked to identify 9 objects, with choices provided. In Part II participants were asked to identify 6 objects using one word only. Part III consisted of identifying the shape of an object in Part II. RESULTS Eighty-nine osteopathic medical students, fellows, residents, and practicing physicians participated in the study. Overall, correct identification of objects was higher in Part I with choices than in Part II without choices available. No statistically significant difference was found among osteopathic medical students, fellows, residents, and practicing physicians in the correct identification of the objects. CONCLUSIONS Accuracy in tactile identification of objects among varying levels of palpatory experience was not found. Correlation with clinical palpation cannot be made as it requires a subset of palpatory skills not tested in this study. Accuracy and measurement of palpation should be studied further to demonstrate if palpatory experience improves palpatory accuracy.
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Affiliation(s)
- Rosanna C Sabini
- Department of Physical Medicine & Rehabilitation, North Shore LIJ - Southside Hospital, 301 East Main Street, Bay Shore, NY 11706, USA.
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Triano JJ, Budgell B, Bagnulo A, Roffey B, Bergmann T, Cooperstein R, Gleberzon B, Good C, Perron J, Tepe R. Review of methods used by chiropractors to determine the site for applying manipulation. Chiropr Man Therap 2013; 21:36. [PMID: 24499598 PMCID: PMC4028787 DOI: 10.1186/2045-709x-21-36] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 08/29/2013] [Indexed: 01/13/2023] Open
Abstract
Background With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. Methods Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation. Results A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement. Conclusions A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.
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Affiliation(s)
- John J Triano
- Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada
| | - Brian Budgell
- Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada
| | | | | | - Thomas Bergmann
- Northwestern Health Sciences University, Bloomington, MN, USA
| | | | - Brian Gleberzon
- Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada
| | - Christopher Good
- University of Bridgeport College of Chiropractic, Bridgeport, CT, USA
| | | | - Rodger Tepe
- Logan College of Chiropractic, Chesterfield, MO, USA
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Henderson CN. The basis for spinal manipulation: Chiropractic perspective of indications and theory. J Electromyogr Kinesiol 2012; 22:632-42. [DOI: 10.1016/j.jelekin.2012.03.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 03/15/2012] [Accepted: 03/20/2012] [Indexed: 12/21/2022] Open
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15
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Reporting new developments in sacroiliac imaging and lymphatic pump techniques. INT J OSTEOPATH MED 2012. [DOI: 10.1016/j.ijosm.2012.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Goode A, Hegedus EJ, Sizer P, Brismee JM, Linberg A, Cook CE. Three-dimensional movements of the sacroiliac joint: a systematic review of the literature and assessment of clinical utility. J Man Manip Ther 2011; 16:25-38. [PMID: 19119382 DOI: 10.1179/106698108790818639] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The high frequency of static and dynamic palpation methods used during evaluation of SIJ problems in clinical practice demands an understanding of the factual quantity of movement at the SIJ. The objective of this systematic literature review was to synthesize three-dimensional (3-D) motion of the sacroiliac joint (SIJ) during various functional static postures and movements and to determine the clinical utility of movement during examination. A computer-based search was performed by means of OVID, which included Medline (February 1966 to April 2007) and CINAHL (February 1982 to April 2007) using the key words Pelvis, Kinematics, Imaging, Three-dimensional, and Stereophotogrammetric. Articles included in-vivo or in-vitro studies that investigated human SIJs with 3-D analysis. Three-dimensional analyses conducted using mathematical modeling, computerized modeling, and/or skin markers were not included because of concerns of transferability and validity. Studies that failed to report standard error of measurement (SEM) or defined tabulated values for translations or rotations using the Cartesian coordinate system were not considered for this study. Studies included for review were analyzed by the SBC biomechanical checklist to measure the quality of procedural design. Seven manuscripts were eligible for inclusion in this study. Rotation ranged between -1.1 to 2.2 degrees along the X-axis, -0.8 to 4.0 degrees along the Y-axis, and -0.5 to 8.0 degrees along the Z-axis. Translation ranged between -0.3 to 8.0 millimeters (mm) along the X-axis, -0.2 to 7.0 mm along the Y-axis, -0.3 to 6.0 mm along the Z-axis. Motion of the SIJ is limited to minute amounts of rotation and of translation suggesting that clinical methods utilizing palpation for diagnosing SIJ pathology may have limited clinical utility.
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Affiliation(s)
- Adam Goode
- Adam Goode, PT, DPT, CSCS, Assistant Professor, Division of Physical Therapy, Department of Community and Family Medicine, Duke University, Durham NC 27710
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Rajendran D, Gallagher D. The assessment of pelvic landmarks using palpation: A reliability study of undergraduate students. INT J OSTEOPATH MED 2011. [DOI: 10.1016/j.ijosm.2010.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fryer G, Johnson JC, Fossum C. The use of spinal and sacroiliac joint procedures within the British osteopathic profession. Part 1: Assessment. INT J OSTEOPATH MED 2010. [DOI: 10.1016/j.ijosm.2010.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Stovall BA, Bae S, Kumar S. Anterior superior iliac spine asymmetry assessment on a novel pelvic model: an investigation of accuracy and reliability. J Manipulative Physiol Ther 2010; 33:378-85. [PMID: 20605557 DOI: 10.1016/j.jmpt.2010.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 03/27/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to develop a novel pelvic model and determine the accuracy and the inter- and intraexaminer reliability of anterior superior iliac spine (ASIS) positional asymmetry assessment from both sides of the model by osteopathic predoctoral fellows and osteopathic physicians and to evaluate the effect of training. METHODS Five osteopathic predoctoral fellows and 5 osteopathic physicians assessed 13 settings of varied ASIS asymmetry of a novel pelvic model for superior/inferior positional asymmetry from both sides of the model in a random order. Assessment from the right and left sides of the model occurred on 2 separate days. Fellows were trained for a week and retested. RESULTS Average interexaminer reliability was greatest from the left side of the model for physicians and from the right side for fellows (physicians: kappa = 0.46, fellows: kappa = 0.37), whereas intraexaminer reliability was greatest from the right in both groups (physicians: kappa = 0.49, fellows: kappa = 0.52). Following training of fellows, interexaminer reliability remained highest from the right side of the model (right: kappa = 0.48, left: kappa = 0.36), whereas intraexaminer reliability was higher from the left side (right: kappa = 0.53, left: kappa = 0.59). Physicians and fellows before training were more accurate from the right side of the model (kappa = 0.56 and kappa = 0.52, respectively). Following training of fellows, accuracy increased from both sides of the model (right: kappa = 0.59, left: kappa = 0.53). CONCLUSIONS A novel pelvic model was developed to allow assessment of accuracy and reliability of ASIS asymmetry assessment. Individually, physicians and fellows varied in accuracy and inter-/intraexaminer reliability. Further investigation is warranted to understand the clinical and educational application of these results.
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Affiliation(s)
- Bradley A Stovall
- Department of Osteopathic Manipulative Medicine, University of North Texas Health Science Center, Texas College of Osteopathic Medicine, Fort Worth, TX 76107, USA
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Stovall BA, Kumar S. Anatomical Landmark Asymmetry Assessment in the Lumbar Spine and Pelvis: A Review of Reliability. PM R 2010; 2:48-56. [DOI: 10.1016/j.pmrj.2009.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 11/01/2009] [Accepted: 11/02/2009] [Indexed: 02/08/2023]
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Berthelot JM, Laslett M. Par quels signes cliniques s’assurer au mieux qu’une douleur est bien d’origine sacro-iliaque (sensu lato) ? ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.rhum.2009.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Reliability of intra- and inter-rater palpation discrepancy and estimation of its effects on joint angle measurements. ACTA ACUST UNITED AC 2009; 14:299-305. [DOI: 10.1016/j.math.2008.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 02/18/2008] [Accepted: 04/13/2008] [Indexed: 11/18/2022]
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