Manual Therapy, 2014/04, 19(2):158-64. doi: 10.1016/j.math.2013.10.002, type of study: ,irs,,,,,,,,,,,,,,,,,,,,,,,,,,

Full text    (https://www.sciencedirect.com/science/article/abs/pii/S1356689X13001823?via%3Dihub)

Keywords:

reliability [164]
validity [29]
observation [249]
osteopathic manipulative treatment [3945]
OMT [3924]
clinical skills [4]
anatomical landmarks [2]
controlled clinical trial [324]

Abstract:

BACKGROUND: Practitioners traditionally use observation to classify the position of patients' anatomical landmarks. This information may contribute to diagnosis and patient management. OBJECTIVES: To calculate a) Inter-rater reliability of categorising the sagittal plane position of four anatomical landmarks (lateral femoral epicondyle, greater trochanter, mastoid process and acromion) on side-view photographs (with landmarks highlighted and not-highlighted) of anonymised subjects; b) Intra-rater reliability; c) Individual landmark inter-rater reliability; d) Validity against a 'gold standard' photograph. DESIGN: Online inter- and intra-rater reliability study. SUBJECTS: Photographed subjects: convenience sample of asymptomatic students; raters: randomly selected UK registered osteopaths. METHODS: 40 photographs of 30 subjects were used, a priori clinically acceptable reliability was >/=0.4. Inter-rater arm: 20 photographs without landmark highlights plus 10 with highlights; Intra-rater arm: 10 duplicate photographs (non-highlighted landmarks). Validity arm: highlighted landmark scores versus 'gold standard' photographs with vertical line. Research ethics approval obtained. RATERS: Osteopaths (n = 48) categorised landmark position relative to imagined vertical-line; Gwet's Agreement Coefficient 1 (AC1) calculated and chance-corrected coefficient benchmarked against Landis and Koch's scale; Validity calculation used Kendall's tau-B. RESULTS: Inter-rater reliability was 'fair' (AC1 = 0.342; 95% confidence interval (CI) = 0.279-0.404) for non-highlighted landmarks and 'moderate' (AC1 = 0.700; 95% CI = 0.596-0.805) for highlighted landmarks. Intra-rater reliability was 'fair' (AC1 = 0.522); range was 'poor' (AC1 = 0.160) to 'substantial' (AC1 = 0.896). No differences were found between individual landmarks. Validity was 'low' (TB = 0.327; p = 0.104). CONCLUSION: Both inter- and intra-rater reliability was 'fair' but below clinically acceptable levels, validity was 'low'. Together these results challenge the clinical practice of using observation to categorise anterio-posterior landmark position.