Manual Examination of the Spine: A Systematic Critical Literature Review of Reproducibility
Received 15 September 2005; received in revised form 2 February 2006
Abstract
Objective
Poor reproducibility of spinal palpation has been reported in previously published literature, and authors of recent reviews have posted criticism on study quality. This article critically analyzes the literature pertaining to the inter- and intraobserver reproducibility of spinal palpation to investigate the consistency of study results and assess the level of evidence for reproducibility.
Methods
Systematic review and meta-analysis were performed on relevant literature published from 1965 to 2005, identified using the electronic databases MEDLINE, MANTIS, and CINAHL and checking of reference lists. Descriptive data from included articles were extracted independently by 2 reviewers. A 6-point scale was constructed to assess the methodological quality of original studies. A meta-analysis was conducted among the high-quality studies to investigate the consistency of data, separately on motion palpation, static palpation, osseous pain, soft tissue pain, soft tissue changes, and global assessment. A standardized method was used to determine the level of evidence.
Results
The quality score of 48 included studies ranged from 0% to 100%. There was strong evidence that the interobserver reproducibility of osseous and soft tissue pain is clinically acceptable (κ ≥ 0.4) and that intraobserver reproducibility of soft tissue pain and global assessment are clinically acceptable. Other spinal procedures are either not reproducible or the evidence is conflicting or preliminary.
aResearch Fellow, Nordic Institute of Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, Odense, Denmark
bSenior Researcher, Nordic Institute of Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, Odense, Denmark
cSenior Researcher, Nordic Institute of Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, Odense, Denmark; and Associate Professor, Institute of Sports Science and Clinical Biomechanics, Part of Clinical Locomotion Science, University of Southern Denmark, Denmark
dProfessor, The Department of Statistics, University of Southern Denmark, Denmark
eProfessor, Center for Outcomes Studies, Western States Chiropractic College, Portland, Ore
fSenior Researcher, The Back Research Center, Backcenter Funen; and Part of Clinical Locomotion Science, University of Southern Denmark, Denmark
hProfessor, Department of Research, Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, Bloomington, Minn
Submit requests for reprints to: Mette Jensen Stochkendahl, DC, Nordic Institute of Chiropractic and Clinical Biomechanics, Research Department, Klosterbakken 20, DK-5000 Odense C, Denmark.
This study was funded by the Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark and the Foundation for Chiropractic Education and Research, grant no. 03-09-01.
ABSTRACT