The Journal of the American Osteopathic Association, 2018/10, 118(10):637-644. doi: 10.7556/jaoa.2018.132, type of study: ,irs,,,,,,,,,,,,,,,,,,,,,,,,,,

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Keywords:

diagnosis [412]
diagnostic tests [6]
osteopathic manipulative treatment [3946]
OMT [3925]
palpation [217]
interexaminer reliability [10]
interrater reliability [54]
osteopathic sacral tests [1]
somatic dysfunction [159]
controlled clinical trial [324]

Abstract:

Context: Somatic dysfunctions are a key element of osteopathic practice. The evaluation of somatic dysfunctions is achieved by assessment of the TART (tissue texture abnormality, asymmetry, restriction of motion, tenderness) parameters. The reliability of a diagnostic method is the crux of successful treatment. Interrater reliability of osteopathic palpatory diagnostic tests have been studied on different anatomical areas, but there are no studies on the evaluation of all of the TART parameters on the sacrum. Objective: To evaluate the interrater reliability of osteopathic sacral palpatory diagnostic tests. The hypothesis was that 3 trained osteopathy students at the end of their curriculum could achieve at least moderate agreement on osteopathic sacral palpatory diagnostic tests. Methods: Three students from the Centre pour l'Etude, la Recherche et la Diffusion Osteopathiques school in Rome, Italy, at the end of their curriculum participated as raters and received consensus training. Eligible subjects among students of the same school were recruited on a voluntary basis to be tested. All of the raters tested the sacrum by evaluating the TART parameters on every subject for 3 minutes. Raters were blinded to the other raters' findings. Interrater reliability was evaluated using Fleiss kappa statistics. Results: Fifty-two subjects (20 women) were enrolled in the study. Mean (SD) age was 25.9 (7.03) years; height, 1.73 (0.09) ms; weight, 68.73 (14.2) kg; and body mass index, 22.66 (3.58). Agreement was fair for tissue texture abnormality (kappa=0.28), asymmetry (kappa=0.29), restriction of motion (kappa=0.32), and tenderness (kappa=0.34); agreement was slight for landmark position (kappa=0.06) and diagnosis of somatic dysfunction (kappa=0.17). Conclusion: Results showed a level of agreement ranging from slight to fair in the assessment of the TART parameters among raters, who were in their last year of osteopathy school. The tenderness parameter was the most reliable. Our findings are consistent with other interrater reliability studies carried out in different body regions, contributing to show an overall heterogeneous level of diagnostic reliability in osteopathy.