Interexaminer reliability of cervical motion palpation using continuous measures and rater confidence levels (original) (raw)
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Interexaminer Reliability of Seated Motion Palpation for the Stiffest Spinal Site
Journal of Manipulative and Physiological Therapeutics, 2018
Objectives: The purpose of this study was to assess the interexaminer reliability of palpation for stiffness in the cervical, thoracic, and lumbar spinal regions. Methods: In this secondary data analysis, data from 70 patients from a chiropractic college outpatient clinic were analyzed. Two doctors of chiropractic palpated for the stiffest site within each spinal region. Each were asked to select the stiffest segment and to rate their confidence in their palpation findings. Reliability between examiners was calculated as Median Absolute Examiner Differences (MedianAED) and data dispersion as Median Absolute Deviation (MAD). Interquartile analysis of the paired examiner differences was performed. Results: In total, 210 paired observations were analyzed. Nonparametric data precluded reliability determination using intraclass correlation. Findings included lumbar MedianAED = 0.5 vertebral equivalents (VE), thoracic = 1.7 VE, and cervical = 1.4 VE. For the combined dataset, the findings were MedianAED = 1.1 VE; MAD was lowest in the lumbar spine (0.3 VE) and highest in thoracic spine (1.4 VE), and for the combined dataset, MAD = 1.1 VE. Examiners agreed on the segment or the motion segment containing the stiffest site in 54% of the observations. Conclusions: Interexaminer reliability for palpation was good between 2 clinicians for the stiffest site in each region of the spine and in the combined dataset. This is consistent with previous studies of motion palpation using continuous analysis.
Strimpakos N Cervical joint position sense An intra and interexaminer reliability study
Objectives: To evaluate the intra-and inter-examiner reliability of neck active joint position sense measurements in different head movements. Methods: Participants had to reproduce actively a specific angle-target in all movements (flexion, right/left rotation, right/left side flexion) from two initial positions, sitting and standing by using a 3D ultrasound-based motion analysis device. Three tests were employed to assess intra-examiner reliability and two examiners used for the inter-examiner reliability. Absolute error (AE) and variable error (VE) indices were used to assess the repositioning accuracy. Intraclass correlation coefficient (I.C.C. (1,1) ), standard error of measurement (S.E.M.), smallest detectable difference (S.D.D.) indices were calculated for the analysis of the results. Results: Both AE and VE yielded poor to moderate I.C.C.s in any movement and position (À0.01 to 0.50 and 0.01-0.25, respectively). AE presented higher I.C.C.s estimates than the VE but the S.D.D.s were similar for both indices. Regarding the AE, the standing position yielded higher I.C.C. estimates (0.15-0.68) than the sitting position (À0.01 to 0.43) but the S.E.M. (1.2-3.08 and 1.5-3.58, respectively) and S.D.D. values (123.3-191.8% and 139.9-203.8%, respectively) showed no specific trend in favour of any position. The VE reliability indices showed that standing position was more reliable with less error than sitting. The inter-examiner data showed similar results to the intra-examiner study. Conclusions: The statistical analysis of the present experiments showed that the method employed for measuring cervical joint position sense is unreliable. However, it needs further research to identify the discriminatory power of these tests or if they are clinically unacceptable. #
Journal of manipulative and physiological therapeutics, 2018
The purpose of this study was to assess the inter- and intra-assessor reliability of the cervical spine device (Formetric, DIERS International GmbH, Schlangenbad, Germany) in measuring cervical range of motion. The cervical spine device was used to measure the cervical range of motion of 65 asymptomatic participants. Flexion-extension, right and left rotation, and right and left lateral flexion were analyzed. Two different assessors performed the measurements on the same day to estimate inter-assessor reliability and 2 days later to examine intra-assessor reliability. Intra-assessor and inter-assessor reliability was assessed using the intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and the smallest detectable difference (SDD) were also estimated. Inter-assessor reliability ICCs for flexion + extension and total lateral flexion movements were >0.90. The ICCs for rotation movements and for left lateral flexion were >0.70. The ICCs for flexion (...
Measurement of cervical sensorimotor control: The reliability of a continuous linear movement test
Manual Therapy, 2014
Background: Cervical sensorimotorcontrol (cSMC) is traditionally assessed by head repositioning accuracy (HRA) measurements. A disadvantage of the HRA measurements is their static character and lack of visual feedback. In 2008, Sjölander et al. developed a continuous linear movement test (CLMT). This CLMT uses several kinematic parameters, such as reduced range of motion (ROM), velocity and movement smoothness, to quantify altered sensorimotor functions. Objective: Investigate the inter and intra rater reliability of a CLMT. Design: Reliability study. Methods: Fifty asymptomatic adults were recruited. Five outcome measures were obtained: the time (t) needed to perform one movement, variation in time (var-t), ROM, peak velocity (peak-v) and Jerk index (C j ). A 3D analysis of cervical movements during the CLMT was made using ZEBRISÔ. MATLABÔ was used to process data provided by the ZEBRISÔ device. These data were used to calculate ICC or k w -values, depending on the normality of the distribution, using SPSS.
Spinal Motion Palpation: A Comparison of Studies That Assessed Intersegmental End Feel Vs Excursion
Journal of Manipulative and Physiological Therapeutics, 2008
Objective: Spinal motion palpation (MP) is a procedure used to detect intersegmental hypomobility/hypermobility. Different means of assessing intersegmental mobility are described, assessing either excursion of the segments (quantity of movement) or end feel (quality of motion when stressed against the paraphysiological space). The objective of this review was to classify and compare studies based on method of MP used, considering that some studies may have used both methods. Methods: Four databases were searched: MEDLINE-PubMed, Manual Alternative and Natural Therapy System, Index to Chiropractic Literature, and Cumulative Index to Nursing and Allied Health Literature databases for the years 1965 through January 2007. Retrieved citations were independently screened for inclusion by 2 of the authors consistent with the inclusion and exclusion criteria. Included studies were appraised for quality, and data were extracted and recorded in tables. Results: The search strategy generated 415 citations, and 29 were harvested from reference lists. After removing articles that did not meet the inclusion criteria, 44 were considered relevant and appraised for quality. Fifteen studies focused on MP excursion, 24 focused on end feel, and 5 used both. Eight studies reported high levels of reproducibility (κ = ≥0.4), although 4 were not of acceptable quality, and 2 were only marginally acceptable. When only high-quality studies were considered, 3 of 24 end-feel studies reported good reliability compared with 1 of 15 excursion studies. There was no statistical support for a difference between the 2 groupings. Conclusions: A difference in reported reliability was observed when the method of MP varied, although it was not statistically significant. There was no support in the literature for the advantage of one MP method over the other. (J Manipulative Physiol Ther 2008;31:616-626)
Journal of Chiropractic Medicine, 2010
Objective: Motion palpation is integral to most chiropractic techniques and can be found in curricula of most every chiropractic college. Paradoxically, most studies do not show strong reliability for motion palpation. The purpose of this study was to determine if allowing motion palpators to rate their confidence in their findings, as well using a continuous data analytic method, would influence the level of concordance. Methods: Subjects were 52 asymptomatic chiropractic student volunteers. Two palpators assessed posterior to anterior glide of T3-10 in the prone position, alternating in their order and blinded as to each other's results. Each examiner identified the location of maximal restriction in this range and also whether they were "very confident" or "not confident" in their finding. Results: For all subjects combined, the examiners' calls were "poor": intraclass correlation coefficient [2,1] = .3110 (95% CI, .0458-.5358). In contrast, interexaminer agreement was "good" when both examiners were very confident: intraclass correlation coefficient [2,1] = .8266 (95% CI, 0.6257-0.9253). Conclusion: When each examiner was "very confident" as to the most fixated thoracic segment, the levels they identified were very close. This corresponds to "good" agreement, an uncommon result in most interexaminer motion palpation studies. Thus, the confidence level of examiners had an effect on the interexaminer reliability of thoracic spine. Our novel continuous measures, statistical methodology, and subtyping the subjects according to the confidence of the palpators seem more capable than level-by-level discrete analysis of detecting interexaminer agreement.
Australasian chiropractic & osteopathy : journal of the Chiropractic & Osteopathic College of Australasia, 1996
A pilot study was conducted to determine whether untrained examiners could agree on palpatory findings in the cervical spine. Fifty-three university students, (most of whom were chiropractic students), had their cervical spines examined by seven different chiropractors using their own clinical methods, of which motion palpation was a common, but not standard component. Chiropractic Centre in Macquarie University. Volunteer university students. Individual clinical methods, which included static and/or motion palpation, vertebral springing, range of motion and applied kinesiology. Statistically, for the total group, there was poor interexaminer reliability. Of eight examiners, four did not disagree significantly, the next two examiners disagreed with each other but only at a single level and the remaining two examiners disagreed with most of the other examiners and each other. In the cervical spine, it appears that C6 is the level of highest contention, followed by C1 and C5. Essentia...
Cervical joint position sense: an intra- and inter-examiner reliability study
Gait & posture, 2006
Objectives: To evaluate the intra-and inter-examiner reliability of neck active joint position sense measurements in different head movements. Methods: Participants had to reproduce actively a specific angle-target in all movements (flexion, right/left rotation, right/left side flexion) from two initial positions, sitting and standing by using a 3D ultrasound-based motion analysis device. Three tests were employed to assess intra-examiner reliability and two examiners used for the inter-examiner reliability. Absolute error (AE) and variable error (VE) indices were used to assess the repositioning accuracy. Intraclass correlation coefficient (I.C.C. (1,1) ), standard error of measurement (S.E.M.), smallest detectable difference (S.D.D.) indices were calculated for the analysis of the results. Results: Both AE and VE yielded poor to moderate I.C.C.s in any movement and position (À0.01 to 0.50 and 0.01-0.25, respectively). AE presented higher I.C.C.s estimates than the VE but the S.D.D.s were similar for both indices. Regarding the AE, the standing position yielded higher I.C.C. estimates (0.15-0.68) than the sitting position (À0.01 to 0.43) but the S.E.M. (1.2-3.08 and 1.5-3.58, respectively) and S.D.D. values (123.3-191.8% and 139.9-203.8%, respectively) showed no specific trend in favour of any position. The VE reliability indices showed that standing position was more reliable with less error than sitting. The inter-examiner data showed similar results to the intra-examiner study. Conclusions: The statistical analysis of the present experiments showed that the method employed for measuring cervical joint position sense is unreliable. However, it needs further research to identify the discriminatory power of these tests or if they are clinically unacceptable. #
Inter-tester reliability of passive intervertebral and active movements of the cervical spine
Manual Therapy, 2006
Measurements of active range of motion (AROM) and passive intervertebral movements (PIM) of the cervical spine are frequently used for patients with neck pain. However, there is a paucity of studies that investigate the psychometric properties of these measurements. Objectives of this study were to: (1) determine the inter-tester reliability of PIM, AROM, and the effects of AROM on symptom provocation; (2) establish the minimal detectable change (MDC) in cervical AROM; and (3) determine the association between AROM and disability. Thirty subjects (age 41712) with neck pain participated in this study. Two masked examiners performed the measurements during the same testing session. PIM was assessed manually and recorded as hypomobile or normal. AROM was measured in degrees with a gravity goniometer. The effect of AROM on patient's symptoms was recorded as no change, decreased, increased, centralization, or peripheralization. Measures of AROM had moderate to substantial reliability (.78-.91) and resulted in a MDC adequate for clinical use (from 91 to 161). The effect of AROM on symptom provocation resulted in Kappa values that ranged from slight to substantial (.25-.87). Measures of PIM resulted in substantial and moderate reliability of assessing occipital-atlas mobility, tenderness of the transverse processes of atlas, and symptom provocation during PIM testing of the lower cervical segments. Fair Kappa values were observed during judgment of mobility in the C2 segment and symptom reproduction during PIM of C2 and C5. The additional PIM had Kappa values that ranged from none to slight. Low prevalence of positive findings likely resulted in an artificial deflation of the Kappa statistic during some PIM measures. Measures of AROM in saggital and transverse planes were associated with disability scores (r ¼ :43 and :40; respectively). Findings are relevant to the planning of future studies to establish the criterion validity of these tests to guide the selection of interventions and establish prognosis in patients with neck pain. r
Rheumatology, 2000
Objectives. To assess the inter-observer and intra-observer reliability of a new threedimensional measurement system, the FASTRAK, in measuring cervical spine flexion/ extension, lateral flexion and rotation and shoulder flexion/extension, abduction and external rotation in healthy subjects. Methods. The study was conducted in two parts. One part assessed inter-observer reliability with two observers measuring 40 subjects. The other part assessed intra-observer reliability with one observer measuring 32 subjects on three occasions. All subjects had unrestricted, pain-free cervical spine and shoulder movement. Reliability was measured by the intraclass correlation coefficient [ICC(2,1)]. Results. The inter-observer ICCs for the cervical spine ranged from 0.61 to 0.89 and for the shoulder from 0.68 to 0.75. After removal of outliers, all ICCs were above 0.70. Intraobserver ICCs for the cervical spine ranged from 0.54 to 0.82 and for the shoulder from 0.62 to 0.81. After removal of outliers, all ICCs were above 0.70 except for shoulder abduction (0.62). Conclusions. Whilst all movements measured by the FASTRAK showed good reliability, the reliability of the whole movement in a plane (e.g. left plus right lateral flexion) was better than for the separate movements (e.g. left and right lateral flexion taken separately). Interobserver reliability was generally better than intra-observer reliability for most cervical spine movements, suggesting that variability of movement within subjects (e.g. over a period of days) for these movements was greater than variability between measures on the same occasion.