RELIABILITY STUDY: IDENTIFYING A DYSFUNCTIONAL SEGMENT IN THE THORACIC AND LUMBAR SPINE

Abstract

Introduction A reliable biomechanical diagnosis is necessary to justify the use of spinal manipulative treatment to correct it. Palpation is considered to be one of the most informative aspects of physical examination of patients with musculoskeletal pain and is the most commonly used method for the examination of the spine for joint dysfunction. Previous studies into reliability of palpation of joint dysfunction are confounded by the clinician having first to correctly identify the appropriate spinal segment, introducing a further measurement error. The purpose of this study was to examine the intra-observer reliability of identifying a manipulable lesion in the lumbar and thoracic spine.

Methods 12 asymptomatic subjects were examined by an experienced osteopath and the selected joint marked on two occasions using a ultra-violet marker rather than by naming the spinal level. The marks were recorded on acetates by a separate researcher and intra-rater reliability was assessed by measuring the agreement between the two markings. Using the palpation examination protocol resulted in an excellent level of intra-rater agreement in the lumbar spine ICC (1,1) .96 but poor reliability ICC (1,1) .70 in the thoracic spine.

Conclusion Intra-rater reliability for identifying a spinal segment exhibiting signs of segmental dysfunction was excellent in the lumbar spine, but poor in the thoracic spine. The examiner was experienced in the examining method for the lumbar spine, but less so in the thoracic spine, highlighting that experience improves palpatory agreement.