Spinal Palpation

This section was compiled by Frank M. Painter, D.C.
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Interexaminer Reliability of Seated Motion Palpation for the Stiffest Spinal Site
J Manipulative Physiol Ther. 2018 (Sep);   41 (7):   571–579 ~ FULL TEXT

More than half the time (54.3%) the examiners in this study agreed on the exact segment or at least the motion segment that was stiff in a given spinal region. The MedianAED for the combined dataset was 01.1 VE. This information supports high levels of interexaminer reliability for the SSS in each region of the spine and in the combined dataset. Reliability estimates based on absolute examiner differences were relatively higher and seemed to be more trustworthy than prior estimates based on discrete analysis and analysis with κ because the assessment method more closely resembled that used by clinicians in clinical practice. The reliability seen in this study is broadly consistent with previous studies of MP using continuous analysis.

The Reliability of Spinal Motion Palpation Determination of the Location
of the Stiffest Spinal Site is Influenced by Confidence Eatings:
A Secondary Snalysis of Three Studies

Chiropractic & Manual Therapies 2016 (Dec 20);   24:   50 ~ FULL TEXT

Neither the confidence module nor the subtyping by spinal region should obscure this study’s central finding: Motion Palpation (MP) for the “stiffest spinal site” (SSS) in the combined dataset, when analyzed using continuous data and related statistical methods, is reliable and appears to identify a clinically relevant and tightly constrained location for the stiffest spinal site; and the variability of the measured interexaminer differences is low. Using a stringent criterion of agreeing on at least the motion segment including the SSS, the described continuous measures palpation protocol was reliable 60.2–77.0% of the time for the combined dataset, and was 90.2% reliable when both examiners were confident. These findings support the view of some authors who have expanded the field of examiner agreement using motion palpation to include nominated segments that are within one level of each other. [30, 41]

The Reliability of Lumbar Motion Palpation Using Continuous Analysis
and Confidence Ratings: Choosing a Relevant Index of Agreement

J Can Chiropr Assoc. 2016 (Jun);   60 (2):   146–157 ~ FULL TEXT

Our results raise the possibility that the present inventory of reliability studies performed in the manual therapy professions, by having used mostly discrete study designs (certainly for MP) may have underestimated clinically relevant examiner agreement, thereby unduly discouraging further research and clinician interest in such research. Moreover, depending solely on ICC calculations to assess interexaminer agreement may result in flawed conclusions, when the subject population is relatively homogeneous. Greater reliance on variance-insensitive statistical functions would mitigate against that possibility. Future studies designed to analyze subsets of the data should use enough subjects to result in credible conclusions.

Validity of Palpation of the C1 Transverse Process:
Comparison with a Radiographic Reference Standard

J Can Chiropr Assoc 2015 (Jun);   59 (2):   91–100 ~ FULL TEXT

Interexaminer agreement for radiometric analysis was "excellent." Stringent accuracy (marker placed ±4mm from the most lateral projection of the C1 TVP) = 57.1%; expansive accuracy (marker placed closer to contiguous structures) = 90.5%. Mean Absolute Deviation (MAD) = 4.34 (3.65, 5.03) mm; root-mean-squared error = 5.40mm.

Review Of Methods Used By Chiropractors
To Determine The Site For Applying Manipulation

Chiropractic & Manual Therapies 2013 (Oct 21);   21 (1):   36 ~ FULL TEXT
A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care-methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine-such as skin conductance or thermography-tend not to be supported by the available evidence.

Interexaminer Reliability of Cervical Motion Palpation Using
Continuous Measures and Rater Confidence Levels

J Can Chiropr Assoc. 2013 (Jun);   57 (2):   156–164 ~ FULL TEXT

For the entire participant pool, ICC [2,1] = 0.61, judged "good." MAD=1.35 cm, corresponding to mean interexaminer differences of about 75% of one cervical vertebral level. Stratification by examiner confidence levels resulted in small subgroups with equivocal results. A continuous measures study methodology for assessing cervical motion palpation reliability showed more examiner concordance than was usually the case in previous studies using discrete methodology.

Interexaminer Reliability of Thoracic Motion Palpation Using
Confidence Ratings and Continuous Analysis

J Chiropractic Medicine 2010 (Sep);   9 (3):   99–106 ~ FULL TEXT

The confidence level of examiners has an effect on the interexaminer reliability of thoracic spine MP, such that agreement is “good” when examiners are “very confident” in their calls and not above chance levels when at least one of them is not. Looking at the data set as a whole, unstratified by degree of examiner confidence, our results resemble those of other investigators, in that the index of agreement is low. Thus, we believe using continuous measures methodology, and defining subgroups according to the confidence of the palpators, is more capable than level-by-level discrete analysis of detecting interexaminer agreement. We also believe our analytic method better reflects what motion palpators, who presumably look for maximally fixated levels within a spinal region logically related to a patient complaint, actually do.

Motion Palpation Used as a Postmanipulation Assessment Tool for Monitoring
End-Feel Improvement: A Randomized Controlled Trial of Test Responsiveness

J Manipulative Physiol Ther. 2009 (Sep);   32 (7):   549–555 ~ FULL TEXT

The findings of this study showed that motion palpation of end-feel assessment appears to be a responsive postmanipulation assessment tool in the cervical spine for determining whether perceived motion restriction found before treatment improves after SMT. This observation may be limited to symptomatic participants.

An Investigation into the Validity of Cervical Spine Motion Palpation
Using Subjects with Congenital Block Vertebrae as a 'Gold Standard'

BMC Musculoskelet Disord 2004 (Jun 15);   5 (1):   19 ~ FULL TEXT

This study indicates that relatively inexperienced examiners are capable of correctly identifying inter-segmental fixations (CBV) in the cervical spine using 2 commonly employed motion palpation tests. The use of a 'gold standard' (CBV) in this study and the substantial agreement achieved lends support to the validity of motion palpation in detecting major spinal fixations in the cervical spine.

Spinal Palpatory Diagnostic Procedures Utilized by Practitioners of
Spinal Manipulation: Annotated Bibliography of Content Validity
and Reliability Studies

J Can Chiropr Assoc 2003 (Jun);   47 (2):   93–109 ~ FULL TEXT

The diagnosis of spinal neuro-musculoskeletal dysfunction is a pre-requisite for application of spinal manual therapy. Different disciplines rely on palpatory procedures to establish this diagnosis and design treatment plans. Over the past 30 years, the osteopathic, chiropractic, physical therapy and allopathic professions have investigated the validity and reliability of spinal palpatory procedures. We explored the literature from all four disciplines looking for scientific papers studying the content validity and reliability of spinal palpatory procedures. Thirteen databases were searched for relevant papers between January 1966 and October 2001. An annotated bibliography of these articles is presented and organized by the type of test used.

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