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Measuring pressures used by physicians and students for cervical diagnosis of segmental somatic dysfunction using the Iso-TOUCH® Palpation Monitor System

Journal: The Journal of the American Osteopathic Association Date: 2007/08, 107(8):Pages: 327-328. doi: Subito , type of study: observational study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2007.107.8.327/html)

Keywords:

cervical spine [290]
diagnosis [394]
medical students [647]
observational study [219]
osteopathic medicine [2025]
palpation [215]
pressure [140]
USA [1656]

Abstract:

For manual medicine (MM) physicians, developing palpatory skills needed to diagnose somatic dysfunction prior to treatment and assess subsequent change is crucial in determining safety and efficacy. Several scientific recording methods have attempted to quantify palpation demonstrated technological limitations. Hypothesis: It was hypothesized that MM students would use more pressure during cervical spine diagnosis than experienced MM practitioners. Methods: 10 osteopathic students and 10 osteopathic physicians palpated the cervical spines of volunteers (n=28, 12 by students, 16 by physicians). At each session a student or physician palpated two volunteers and then reported the side-bending/rotational motion characteristics of the perceived “worst segment.” A prototypic Iso-TOUCH® Palpation Monitor System (Neuromuscular Technologies) was developed to provide instrumentation to quantify pressure ranges used by successful practitioners to accurately diagnose (and later, successfully treat) somatic dysfunction. This technology utilizes finger, thumb and palm sensors to measure contact pressures during palpation of a given body region. Finger pressures over the cervical articular pillars during side-bending and rotation were recorded and graphed by customized Iso-TOUCH® software. They were analyzed using a one-factor analysis of variance test performed by the PCOM statistician. The PCOM Institutional Review Board approved this study. Results: In comparing all students to physicians, students used an average of 0.82 Lbs more palpatory pressure (p<0.01) than physicians (1.22-2.88 versus 1.03-1.30 Lbs). Additionally, physicians were found to compress the soft tissues prior to motion testing using 0.39 Lbs while students did not compress the tissues at all (p<0.01). Of the 10 students, 7 used more force than any physician palpator. The remaining 3 students used more force than most (7 of 10) of the physicians. Conclusion: This study tends to confirm the hypothesis that as palpatory skills develop, less pressure is required to accurately diagnose somatic dysfunction. Furthermore, experienced clinicians incorporated loading pressures omitted by students. Based upon these findings, future studies are warranted with this technology to document palpation characteristics. Studies in educational settings are also planned to determine if this real-time feedback system might improve palpatory skills and confidence of future practitioners.


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