A study of the inter-rater reliability of passive spinal motion palpation of the cervical spine in an asymptomatic student population when assessed by experienced osteopaths

Authors:
  • Meredith Giles
Keywords: Osteopathy, palpation, reliability, reproducibility, manipulation, spinal mobility
Type of Publication: Thesis/Dissertation
Institute: British School of Osteopathy
Publication date: 2011 Entry date: 2012 February, 03
Status: Finished Recommended: No
Country: United Kingdom Language: English
Available at: http://bso-web.bso.ac.uk/BSO-All/Library-public/IntranetTest/PROJECTS_2011_files/Projects/MeredithGiles.doc

Abstract

Background: Motion palpation (MP) is frequently used by osteopaths and other manual therapists as part of the diagnostic assessment (Fryer et al 2010), to assess the passive range of motion of joints, assuming that motion abnormalities contribute to pain (Hestbaek & Leboeuf- Yde 2000; Huijbregts 2002). Many studies have assessed the reliability of MP, generally finding reliability to be low (see reviews by Seffinger et al. 2004; Stochkendahl et al. 2006; Haneline, & Young 2009). It is important for clinical procedures to be reliable, accurate and valid (Haneline & Young 2009); particularly regarding the cervical spine where concerns have been raised over associated risk factors of manual therapy techniques (Ernst 2007; Ernst 2010).

Objectives: To assess the inter-rater reliability of experienced osteopaths. To assess for order effects i.e. whether perceived restrictions reduced with successive examination of each subject.

Method: Six osteopaths, each with at least five years experience, palpated the cervical spines of five asymptomatic subjects to assess the degree of mobility restriction present at each segment, relative to other cervical segments. These results were analysed using a Multivariate Iota to estimate inter-rater reliability. The test for order effects was carried out by using simple linear regression and estimating the slope parameter, the significance of which was estimated with a t-test.

Results: For inter-rater reliability the Iota value was 0.00162, suggesting negligible reliability. For order effect the p values were not significantly different to zero, suggesting negligible order effect.

Conclusions: The results were disappointing for osteopathy but, despite certain study limitations, were consistent with previous similar research. Speculation can be made as to factors for this, and future research could focus on these. It may also be beneficial to assess how methods such as MP are used clinically.

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Abstract (English)

Title: A study of the inter-rater reliability of passive spinal motion palpation of the cervical spine in an asymptomatic student population when assessed by experienced osteopaths

Background: Motion palpation (MP) is frequently used by osteopaths and other manual therapists as part of the diagnostic assessment (Fryer et al 2010), to assess the passive range of motion of joints, assuming that motion abnormalities contribute to pain (Hestbaek & Leboeuf- Yde 2000; Huijbregts 2002). Many studies have assessed the reliability of MP, generally finding reliability to be low (see reviews by Seffinger et al. 2004; Stochkendahl et al. 2006; Haneline, & Young 2009). It is important for clinical procedures to be reliable, accurate and valid (Haneline & Young 2009); particularly regarding the cervical spine where concerns have been raised over associated risk factors of manual therapy techniques (Ernst 2007; Ernst 2010).

Objectives: To assess the inter-rater reliability of experienced osteopaths. To assess for order effects i.e. whether perceived restrictions reduced with successive examination of each subject.

Method: Six osteopaths, each with at least five years experience, palpated the cervical spines of five asymptomatic subjects to assess the degree of mobility restriction present at each segment, relative to other cervical segments. These results were analysed using a Multivariate Iota to estimate inter-rater reliability. The test for order effects was carried out by using simple linear regression and estimating the slope parameter, the significance of which was estimated with a t-test.

Results: For inter-rater reliability the Iota value was 0.00162, suggesting negligible reliability. For order effect the p values were not significantly different to zero, suggesting negligible order effect.

Conclusions: The results were disappointing for osteopathy but, despite certain study limitations, were consistent with previous similar research. Speculation can be made as to factors for this, and future research could focus on these. It may also be beneficial to assess how methods such as MP are used clinically.