The Journal of the American Osteopathic Association, 2011/08, 111(8):490. doi: 10.7556/jaoa.2011.111.8.487, type of study: ,irs,,,,,,,,,,,,,,,,,,,,,,,,,,

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2011.111.8.487/html)

Keywords:

diagnosis [412]
inter-examiner reliability [19]
palpation [217]
pressure feedback [1]
pretest posttest design [240]

Abstract:

Background: Diagnostic palpation is a vital skill for manual practitioners. Interexaminer reliability studies using the kappa (κ) statistic to help identify useful palpatory tests and how they are taught. Interexaminer reliability studies of the right Anterior Superior Iliac Spine (ASIS) Compression Test (Test) were previously reported. Using data from 330 subjects gathered by 2 osteopathic medical students, the κ statistic was applied to prevalence index controlled subgroups. Performed from the subject's right side, the Test rated “excellent” (κ=0.80) in female subjects, “fair” overall (κ=0.43), but “poor” for male subjects and for any left-sided assessment. Hypothesis: Studies of the ASIS Compression Test in both genders will benefit from feedback monitors to insure bilaterally consistent engagement pressures; that without feedback, examiners misjudge right-left pressure. Feedback will improve agreement and increase κ values even in a population where prevalence index is not controlled. Methods: The same 2 examiners from our prior study replicated the Test on 6 men and 6 women. Pressure sensitive material over finger pads and thenar eminences (IsoTOUCH Palpation Monitors; Neuromuscular Technologies: Nashville, TN) sent instantaneous data to a computer display screen. Two separate trials conducted on different days used the same 12 subjects. From the supine subject's right side, 2 sequential pulsatile ASIS compressions were transmitted posteromedially (60° from horizontal) towards S3; the side of greatest end-feel resistance denoted “positive.” In trial 1, both examiners were blinded to pressure data. In trial 2, they were directed to use 6 to 8 lbs bilateral engagement pressures using live monitoring feedback. Results: In the same healthy population (without prevalence index controls), feedback improved the κ statistic from 0.059 to 0.571 (left positivity) and -0.05 to 0.47 (right positivity). In females, κ values improved from 0.08 to 0.67 (left) and from 0.36 to 0.67 (right). Feedback did not improve reliability in male subjects. Conclusion: Using objective pressure feedback during the ASIS Compression Test greatly increases interexaminer reliability; such technology could enhance efforts to document and improve manual skills. Pressure feedback improved right-left issues without changing sides to perform the Test. It did not resolve male-female κ differences where variables such as Test pressure application angles may need study.