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Correlation of Osteopathic Examination of the Thoracic Spine With Ultrasound Examination
Maddox, J. M. [1]
Chang, S. Y. [1]
Dobrusin, R. S. [1]
Nakken, N. G. [1]
Stein, A. B. [3]
Noble, J. [2]
Nydam, R. L. [2]

Journal: The Journal of the American Osteopathic Association Date: 2020/12, 120(12):Pages: e67-e68. doi: Subito , type of study: observational study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2020.157/html)

Keywords:

diagnosis [394]
observational study [219]
palpation [215]
thoracic spine [84]
ultrasound [49]

Abstract:

Statement of Significance: There has been literature published regarding using ultrasonography as a clinical tool to evaluate segmental motion for the cervical, lumbar, and sacral regions in the osteopathic clinical setting. However, no research has yet been published that compares osteopathic structural examination of the thoracic vertebral region to ultrasonographic examination. This study seeks to determine whether there is a significant correlation between osteopathic palpation and ultrasonographical measurements, as well as examine reliability between individual clinical examinations and ultrasound measurements. Research Methods: Participants were volunteers recruited from the Midwestern University student body. A non-toxic, non-permanent marker was used to mark the skin. Two osteopathic physicians (OMM1, OMM2) separately performed structural examinations by palpating T2-T5 transverse processes to determine vertebral rotation. Two trained sonographers (US1, US2) separately scanned and measured the distance from the tip of the spinous process to the adjacent transverse processes of the vertebral segment below. Demographic variables were summarized with mean and SD. Interexaminer reliability was assessed with percent agreement, Cohen's kappa, and Fleiss’ kappa. Recruitment and protocols were approved by the MWU Institutional Review Board. Data Analysis: Our results showed that when using two examiners for ultrasound, there is fair agreement for the overall “most significant” segmental rotation of the upper thoracic spine, with Cohen's Kapp at 0.27, with range of 0.09, 0.45, and total agreement percentage at a 52%. For osteopathic examination, there is no statistic agreement for the overall upper thoracic spine, with a Cohen's Kappa at 0.05 (0.0, 0.27), and 32%. Both US1 and US2 had slight agreement with one of the OMM examiners (OMM2), with Cohen's kappa of 0.14 (0.0, 0.33), 33% and 0.11 (0.0, 0.30), 30%, respectively. However, if we analyzed each segment individually, we see that at T3, US1 and US2 has slight agreement at 0.20 (0.02, 0.37) and 48%, while OMM1 and OMM2 did not show agreement [0.01 (0.0, 0.12)], but had 44% agreement. There is slight agreement between US1 and OMM2 [0.10 (0.03, 0.23)]. At T4, US1 and US2 again has slight agreement at 0.2 (0.02, 0.38) and 48%, and OMM 1 vs OMM 2 did not have agreement with 0.08 (0.0, 0.24) and 39% . There are no significant US and OMM agreements. At T5, US1 and US2 had moderate agreement at 0.44 (0.27, 0.60), or 64%. OMM 1 and OMM2 had slight agreement at 0.12 (0.0, 0.28), or 42%. There are no significant US and OMM agreements to each other. Fleiss’ Kappa compares all raters at once: US1, US2, OMM1, and OMM2 (66 participants and 4 raters). This Fleiss’ Kappa indicates at T3 is -0.0512, 0.0287 at T4, and 0.0794 at T5, indicating low levels of agreements. Results: Our results showed that ultrasound (US) had fair agreement for the overall most prominent segmental rotation of the upper thoracic spine. Osteopathic (OMM) palpation revealed no agreement for the overall most prominent vertebral rotation. Segment-specific vertebral analysis revealed slight agreement between US1 and OMM2 at the T3 vertebral segment, slight agreement between US1 and US2 at T4, and moderate agreement between US1 and US2 and slight agreement between OMM1 and OMM2 at T5. There are no significant ultrasound and OMM agreements to each other. Conclusion: Osteopathic structural palpation had low interexaminer reliability, which is consistent with the literature. Ultrasound was found to have demonstrably better, albeit still relatively low, interexaminer reliability. We caution that palpation alone is not sufficiently reliable for diagnosis. We also find that ultrasound alone, while a demonstrably broadly applicable medical technology, is also likely not sufficiently reliable for diagnosis of thoracic somatic dysfunction. The low levels of correlation may stem from the fact that most participants were asymptomatic. Future study that looks at ultrasound and OMM examination correlation on a clinically symptomatic population may yield further findings. Furthermore, future studies should assess the pre- and post-treatment correlation of ultrasound and osteopathic examinations.

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