Journal of Manipulative and Physiological Therapeutics
Literature ReviewManual Examination of the Spine: A Systematic Critical Literature Review of Reproducibility
Section snippets
Definitions
Palpation was defined according to Bergmann and Petersen,1 and results of the original articles were analyzed according to the palpation procedure, using the following annotations: motion palpation (MP), static palpation (SP) (palpation for alignment and/or structure), osseous pain (OP) (pain generated from palpation of osseous structures), soft tissue pain (STP), soft tissue changes (STC), and global assessment (GA) (the latter was introduced to describe the use of 2 or more of the above
Results of the Literature Search
More than 900 publications were retrieved, and 48 original articles published between 1980 and 2005 were included according to the inclusion criteria.20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67 In all 48 studies interobserver reproducibility were reported, and in 19 studies, intraobserver reproducibility was also reported (Appendix A, Appendix B,
Summary of Results
After reviewing studies dealing with reproducibility of manual palpation of the entire spine, including the SI joints, we found strong evidence for clinically acceptable reproducibility both within and between observers for palpation of osseous and STP and within the same observer for GA. Strong evidence for clinically unacceptable levels of reproducibility for intra- and interobserver MP and STC was found. Intraobserver reproducibility was consistently higher than interobserver
Conclusions
Palpation for pain is reproducible at a clinically acceptable level, both within the same observer and among observers. Palpation for GA is reproducible within the same observer but not among different observers. The level of evidence to support these conclusions is strong. The reproducibility of MP, STC, and SP is not clinically acceptable. The level of evidence is strong for interobserver reproducibility of MP and STC, whereas no evidence or conflicting evidence exists for SP and
References (78)
- et al.
Clinical tests of the sacroiliac joint. A systemic methodological review. Part 1: reliability
Man Ther
(2000) The dependence of Cohen's kappa on the prevalence does not matter
J Clin Epidemiol
(2005)Inter-examiner reliability in detecting cervical spine dysfunction: a short review
J Osteopath Med
(2002)- et al.
Meta-analytic methods for diagnostic test accuracy
J Clin Epidemiol
(1995) - et al.
The interexaminer reproducibility of physical examination of the cervical spine
J Manipulative Physiol Ther
(2004) - et al.
Interexaminer reliability in physical examination of the cervical spine
J Manipulative Physiol Ther
(1999) - et al.
Interrater reliability of clinical examination measures for identification of lumbar segmental instability
Arch Phys Med Rehabil
(2003) - et al.
Can manipulative physiotherapists agree on which lumbar level to treat based on palpation?
Physiotherapy
(2003) - et al.
Palpation of the upper thoracic spine—an observer reliability study
J Manipulative Physiol Ther
(2002) - et al.
Measurement challenges in physical diagnosis: refining interrater palpation, perception and comminication
J Bodyw Mov Ther
(2001)
Inter-examiner reliability of the Johnson and Friedman percussion scan of the thoracic spine
J Osteopath Med
Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain
J Manipulative Physiol Ther
Inter-examiner reliability in assessing passive intervertebral motion of the cervical spine
Man Ther
Inter-examiner and intra-examiner reliability of standing flexion test
Man Ther
Preliminary study of the reliability of assessment procedures for indications for chiropractic adjustments of the lumbar spine
J Manipulative Physiol Ther
Upper cervical instability: are clinical tests reliable?
Man Ther
Inter-examiner reliability to detect painful upper cervical joint dysfunction
Aust J Physiother
Counterstrain and traditional osteopathic examination of the cervical spine compared
J Bodyw Mov Ther
Unravelling the fetal origins hypothesis: is there really an inverse association between birthweight and subsequent blood pressure?
Lancet
Joint principles and procedures
Introduction to the dynamic chiropractic paradigm
Vertebral manipulation
Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A systematic critical literature review
J Manipulative Physiol Ther
Spinal motion palpation: a review of reliability studies
J Man Manip Ther
Reliability of spinal palpation for diagnosis of back and neck pain: a systematic review of the literature
Spine
Statistical methodology for reliability studies
J Manipulative Physiol Ther
Method guidelines for systematic reviews in the Cochrane collaboration back review group for spinal disorders
Spine
Cochrane reviewers' handbook 4.2.0
Systematic review of psychosocial factors at work and private life as risk factors for back pain
Spine
Reproducibility and validity studies of diagnostic procedures in manual/musculoskeletal medicine
Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests
BMJ
Some common problems in medical research
Acute low back problems in adults. Clinical Practice Guideline No. 14
Psychosocial factors at work in relation to low back pain and consequences of low back pain; a systematic, critical review of prospective cohort studies
Occup Environ Med
Interexaminer reliability in physical examination of the neck
J Manipulative Physiol Ther
Interexaminer reliability in physical examination of patients with low back pain
Spine
Interexaminer reliability of eight evaluative dimensions of lumbar segmental abnormality
J Manipulative Physiol Ther
Interexaminer reliability of observations in physical examinations of the neck
Phys Ther
Reliability of palpation assessment in non-neutral dysfunctions of the lumbar spine
Orthop Phys Ther Pract
Cited by (0)
This study was funded by the Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark and the Foundation for Chiropractic Education and Research, grant no. 03-09-01.