International Journal of Osteopathic Medicine, 2005/12, 8(4):131-138. doi: 10.1016/j.ijosm.2005.08.004, type of study: ,irs,,,,,,,,,,,,,,,,,,,,,,,,,,

Full text    (https://www.sciencedirect.com/science/article/pii/S1746068905000921)

Keywords:

reliability [164]
palpation [217]
sacroiliac [79]
osteopathic manipulative treatment [3946]
OMT [3925]
inter rater reliability [14]
controlled clinical trial [324]

Abstract:

Objective To investigate the effect of training and standardisation of technique on the inter-examiner and intra-examiner reliability of static palpation of pelvic landmarks and the seated flexion test (SFT), which are commonly advocated for the detection of sacroiliac dysfunction. Methods Two groups of final year osteopathic students (N=10) examined 10 asymptomatic female subjects for symmetry of pelvic landmarks and the SFT. One group of examiners (n=5) attended two training sessions in order to standardise their examination techniques, whereas those in the ‘untrained’ group (n=5) did not. Three assessments of the symmetry of the anterior superior iliac spine (ASIS), posterior superior iliac spine (PSIS), medial malleoli (MM), sacral inferior lateral angle (SILA) and SFT were performed on every subject by all examiners. Examiner agreement was analysed using Cohen's weighted kappa (κ) statistic. Results The trained group produced slightly higher intra-examiner reliability for three of the four landmarks and the SFT, and slightly higher inter-examiner reliability for two of the four landmarks and the SFT. Intra-examiner reliability was higher than inter-examiner reliability. The level of inter-examiner agreement in the trained group was fair for palpation of the MM (trained, κ=0.31; untrained, κ=0.28) and ASIS (trained, κ=0.24; untrained, κ=−0.01), slight for the SFT (trained, κ=0.14; untrained, κ=0.07), PSIS (trained, κ=0.08; untrained, κ=0.15) and SILA (trained, κ=0.04; untrained, κ=−0.01). Conclusions Those examiners who attended training sessions achieved a marginal increase in intra-examiner and inter-examiner reliability, but concordance was still less than acceptable for a clinical test. The osteopathic profession should reconsider the use of these clinical tests purported to indicate sacroiliac dysfunction in view of their unestablished validity and poor inter-examiner reliability.