Author(s): Seffinger, Michael A; Najm, Wadie I; Mishra, Shiraz I; Adams, Alan; Dickerson, Vivian M; Murphy, Linda S; Reinsch, Sibylle | Abstract: A systematic review.To determine the quality of the research and assess the interexaminer and intraexaminer reliability of spinal palpatory diagnostic procedures.Conflicting data have been reported over the past 35 years regarding the reliability of spinal palpatory tests.The authors used 13 electronic databases and manually searched the literature from January 1, 1966 to October 1, 2001. Forty-nine (6%) of 797 primary research articles met the inclusion criteria. Two blinded, independent reviewers scored each article. Consensus or a content expert reconciled discrepancies.The quality scores ranged from 25 to 79/100. Subject description, study design, and presentation of results were the weakest areas. The 12 highest quality articles found pain provocation, motion, and landmark location tests to have acceptable reliability (K = 0.40 or greater), but they were not always reproducible by other examiners under similar conditions. In those that used kappa statistics, a higher percentage of the pain provocation studies (64%) demonstrated acceptable reliability, followed by motion studies (58%), landmark (33%), and soft tissue studies (0%). Regional range of motion is more reliable than segmental range of motion, and intraexaminer reliability is better than interexaminer reliability. Overall, examiners' discipline, experience level, consensus on procedure used, training just before the study, or use of symptomatic subjects do not improve reliability.The quality of the research on interreliability and intrareliability of spinal palpatory diagnostic procedures needs to be improved. Pain provocation tests are most reliable. Soft tissue paraspinal palpatory diagnostic tests are not reliable.

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Reliability of spinal palpation for diagnosis of back and neck pain: a systematic review of the literature.

black small square) Methods • (black small square) Results o The Inclinometer Technique With and Without Fluoroscopic Determination of Reference Points o Interrater Correlation With the Inclinometer Technique o Functional Radiography Compared With the Inclinometer

Lumbar range of motion: reliability and validity of the inclinometer technique in the clinical measurement of trunk flexibility

Manual Examination of the Spine: A Systematic Critical Literature Review of Reproducibility

The purpose of this systematic review was to determine the quality of the research and to assess the reliability of different types of physical examination procedures used in the assessment of patients with non-specific low back pain. A search of electronic databases (MEDLINE, PEDro, AMED, EMBASE, Cochrane, and CINAHL) up to August 2005 identified 48 relevant studies which were analysed for quality and reliability. Pre-established criteria were used to judge the quality of the studies and satisfactory reliability, and conclusions emphasised high quality studies (≥ 60% methods score). The mean quality score of the studies was 52% (range 0 to 88%), indicating weak to moderate methodology. Based on the upper threshold used (kappa/ICC > 0.85) most procedures demonstrated either conflicting evidence or moderate to strong evidence of low reliability. When the lower threshold was used (kappa/ICC > 0.70) evidence about pain response to repeated movements changed from contradictory to moderate evidence for high reliability. Most procedures commonly used by clinicians in the examination of patients with back pain demonstrate low reliability. [May S, Littlewood C and Bishop A (2006): Reliability of procedures used in the physical examination of non-specific low back pain: A systematic review. Australian Journal of Physiotherapy 52: 91–102]

D M Panzer

Papers

The reliability of lumbar motion palpation.