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Journal: The AAO Journal Date: 2024/06, 34(2):Pages: 15. doi: Subito , type of study: Intra- inter rater reliability study

Keywords:

diagnosis [371]
hips [13]
inter-rater reliability [15]
randomized controlled trial [867]

Abstract:

Introduction: “Resetting the Hips”(RTH) is taught and performed in Osteopathy to align the pelvis prior to diagnosing innominate somatic dysfunction (I-SD). The literature discusses RTH but efficacy has not been reported. Our 2023 ECOP survey confirmed variable COM teaching of active versus passive RTH. Our 2023 pilot study revealed no significant impact of RTH on I-SD diagnosis. This study aimed to further elucidate if RTH impacts I-SD diagnosis utilizing a statistically significant sample size, additional examiner, and stricter methodology. We hypothesize RTH will not impact I-SD diagnosis. Methods: We conducted a prospective, randomized control study of 150 OMSs into 3 groups: No RTH, active RTH, and passive RTH. An ONMM3 resident and OMM faculty performed blinded landmark assessments pre/post-RTH, while a second OMM faculty assessed only post-manuever. We utilized a paired design with RMLE-based score test comparison. Inter and intra-evaluator agreement was assessed using 3 methods: paired average proportion, intraclass correlation coefficients (ICC), weighted kappa symmetry. Results: Following RTH (active & passive), I-SD diagnosis remained unchanged at both locations 78% of time (evaluator 1) and 47% (evaluator 2). Single locations remained unchanged: ASIS position: 87% (evaluator 1); 67% (evaluator 2); MM position: 87% (evaluator 1); 65% (evaluator 2). There was consistently poor agreement between 3 evaluators. For example, post-manuever ASIS diagnosis overall agreement, (43%, ICC 0.27); following RTH, (45%, ICC 0.31). Discussion/Conclusion: These findings support our hypothesis that RTH does not impact I-SD diagnosis per evaluator; however, overall interrater reliability was very poor and strict eye dominance did not impact results. Limitations include: recruitment population and interrater reliability. Future studies could evaluate subtle change vs marked landmark change diagnoses and other causes of poor interrater reliability.

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