Inter-examiner Reliability of the Interpretation of Paraspinal Thermographic Pattern Analysis

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SOURCE:   J Can Chiropr Assoc 2015 (Jun);   59 (2):   157-164 ~ FULL TEXT

Barbara A. Mansholt, DC, MS, Robert D. Vining, DC,
Cynthia R. Long, PhD, Christine M. Goertz, DC, PhD

Associate Professor, Clinic,
Palmer College of Chiropractic

INTRODUCTION:   A few spinal manipulation techniques use paraspinal surface thermography as an examination tool that informs clinical-decision making; however, inter-examiner reliability of this interpretation has not been reported. The purpose of this study was to report inter-examiner reliability for classifying cervical paraspinal thermographic findings.

METHODS:   Seventeen doctors of chiropractic self-reporting a minimum of 2 years of experience using thermography classified thermographic scans into categories (full pattern, partial +, partial, partial -, and adaptation). Kappa statistics (k) were calculated to determine inter-examiner reliability.

RESULTS:   Overall inter-examiner reliability was fair (k=0.43). There was good agreement for identifying full pattern (k=0.73) and fair agreement for adaptation (k=0.55). Poor agreement was noted in partial categories (k=0.05-0.22).

CONCLUSION:   Inter-examiner reliability demonstrated fair to good agreement for identifying comparable (full pattern) and disparate (adaptation) thermographic findings; agreement was poor for those with moderate similarity (partial). Further research is needed to determine whether thermographic findings should be used in clinical decision-making for spinal manipulation.

From the FULL TEXT Article:


Doctors of chiropractic (DCs) use complex clinical decision-making when determining where, when, and when not to perform spinal manipulation. [1] Factors considered may include the diagnosis, symptom severity, presence of co-morbid conditions, patient preferences, and other examination findings [2, 3] such as static or segmental motion palpation, [4, 5] posture analysis, leg length analysis, [6] biomechanical interpretation of spinal radiographs, the presence of spinal/paraspinal tenderness, and abnormal muscle tone. [7] Some chiropractic spinal manipulation techniques, particularly those focusing on upper cervical manipulation, use thermographic and other diagnostic instruments to provide primary information to determine whether treatment should or should not occur. [8] The use of unique diagnostic instrumentation is not new to the chiropractic profession. B.J. Palmer, considered the “developer” of chiropractic, used an instrument called the electroencephaloneuromentimpograph and later, the neurocalometer. [9] The neurocalometer was the predecessor of the current nervo-scope, which is still used by some practitioners using the Gonstead technique system. [10, 11]

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A few studies indicate that there may be some potential for thermography to provide information suggestive of underlying physiological processes [12] that may help inform spinal manipulation decisions. [13] Roy reported changes in paraspinal surface temperature (comparing one side to the opposite side) using infrared thermographic methods following spinal manipulation. [14, 15] These findings suggest that paraspinal cutaneous and/or subcutaneous blood perfusion may be altered following spinal manipulation. However, without further study, it is unclear if these findings represent specific physiological mechanisms initiated by the manipulation or simply from normal changes over time or from tissue perturbation.

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