The Journal of the American Osteopathic Association, 2011/08, 111(8):489. 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]
lumbar spine [65]
palpation [217]
pretest posttest design [241]
thoracic spine [98]
training [92]

Abstract:

Hypothesis: Osteopathic physicians commonly use diagnostic palpation to determine the presence of somatic dysfunction of the spine and resolution of the finding posttreatment. However, the reliability of this primary diagnostic measure has not been established. Objective: To determine if short-term examiner training by a specialist on palpation methodology has an impact on observer concordance and if interrater agreement differs by anatomic location. Methods: The thoracic and lumbar spine subgroup sessions of this study were conducted during separate timeframes, had different subgroup sets of examiners, and followed the same methods. Subjects (thoracic, n=60; lumbar, n=60; total, N=120) recruited for this study were asymptomatic. In the pretraining sessions, 4 board examiners independently evaluated T3-T7 (n=30) and L1-L5 (n=30) spinal segments for rotational asymmetry and rated the severity of the finding. Examiners underwent 2 training sessions to standardize the examination method and held 3 rehearsal sessions. In the posttraining sessions, the examiners used the standardized methods to evaluate the same thoracic (n=30) and lumbar (n=30) spinal segments as in the pretraining sessions. Kappa (κ) statistics were used to compare pre- and posttraining interexaminer reliability results. Results: Poor to fair interexaminer agreement was demonstrated in the pretraining sessions with κ scores of 0.067 to 0.325 (thoracic) and from 0.00 to 0.300 (lumbar). In contrast, moderate to substantial interexaminer concordance was obtained following the posttraining sessions with κ scores of 0.467 to 0.650 (thoracic) and 0.458 to 0.650 (lumbar). No statistically significant difference was found on observer agreement by anatomic location (pretraining, P=.168; posttraining, P=.287). Conclusion: The results of this study suggest that short-term training with standardization of the palpation methods used by the examiners improves interexaminer agreement and that examiner concordance does not differ by anatomic location.