Journal of Manipulative and Physiological Therapeutics
Volume 29, Issue 6 , Pages 475-485.e10 , July 2006

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

  • Mette Jensen Stochkendahl, DC

      Affiliations

    • Research Fellow, Nordic Institute of Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, Odense, Denmark
    • Corresponding Author InformationSubmit requests for reprints to: Mette Jensen Stochkendahl, DC, Nordic Institute of Chiropractic and Clinical Biomechanics, Research Department, Klosterbakken 20, DK-5000 Odense C, Denmark.
    • ,
  • Henrik Wulff Christensen, DC, MD, PhD

      Affiliations

    • Senior Researcher, Nordic Institute of Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, Odense, Denmark
    • ,
  • Jan Hartvigsen, DC, PhD

      Affiliations

    • Senior 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
    • ,
  • Werner Vach, PhD

      Affiliations

    • Professor, The Department of Statistics, University of Southern Denmark, Denmark
    • ,
  • Mitchell Haas, DC, MA

      Affiliations

    • Professor, Center for Outcomes Studies, Western States Chiropractic College, Portland, Ore
    • ,
  • Lise Hestbaek, DC, PhD

      Affiliations

    • Senior Researcher, The Back Research Center, Backcenter Funen; and Part of Clinical Locomotion Science, University of Southern Denmark, Denmark
    • ,
  • Alan Adams, DC, MS, MSEd

      Affiliations

    • Professor, Texas Chiropractic College, Pasadena, Tex
    • ,
  • Gert Bronfort, DC, PhD

      Affiliations

    • Professor, Department of Research, Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, Bloomington, Minn

Received 15 September 2005 ,Revised 2 February 2006

References 

  1. Bergmann TF, Petersen DH. Joint principles and procedures. In:  Bergmann TF,  Petersen DH,  Lawrence DJ editor. Chiropractic technique: principles and procedures. New York: Churchill Livingstone Inc; 1993;p. 51–121
  2. Schafer RC, Faye LJ. Introduction to the dynamic chiropractic paradigm. In:  Schafer RC,  Faye LJ editor. Motion palpation and chiropractic technique. 1st ed.. Huntington Beach, Calif: The motion palpation institute; 1989;p. 1–41
  3. Maitland GD. Vertebral manipulation. 3rd ed.. London: Butterworths; 1977;
  4. Hestbaek L, Leboeuf-Yde C. Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A systematic critical literature review. J Manipulative Physiol Ther. 2000;23:258–275
  5. Huijbregts PA. Spinal motion palpation: a review of reliability studies. J Man Manip Ther. 2002;10:24–39
  6. van der Wurff P, Hagmeijer RH, Meyne W. Clinical tests of the sacroiliac joint. A systemic methodological review. Part 1: reliability. Man Ther. 2000;5:30–36
  7. Seffinger MA, Najm WI, Mishra SI, Adams A, Dickerson VM, Murphy LS, et al. Reliability of spinal palpation for diagnosis of back and neck pain: a systematic review of the literature. Spine. 2004;29:E413–E425
  8. Haas M. Statistical methodology for reliability studies. J Manipulative Physiol Ther. 1991;14:119–132
  9. Vach W. The dependence of Cohen's kappa on the prevalence does not matter. J Clin Epidemiol. 2005;58:655–661
  10. Vaughan B. Inter-examiner reliability in detecting cervical spine dysfunction: a short review. J Osteopath Med. 2002;5:24–27
  11. van Tulder MW, Assendelft WJ, Koes BW, et al. Method guidelines for systematic reviews in the Cochrane collaboration back review group for spinal disorders. Spine. 1997;22:2323–2330
  12. Clarke M, Oxmann AD. Cochrane reviewers' handbook 4.2.0. Oxford: Cochrane Collaboration; 2003;cited 2004 Jun 1
  13. Hoogendoorn WE, van Poppel MN, Bongers PM, Koes BW, Bouter LM. Systematic review of psychosocial factors at work and private life as risk factors for back pain. Spine. 2000;25:2114–2125
  14. Patijn J. Reproducibility and validity studies of diagnostic procedures in manual/musculoskeletal medicine. In: International Federation for Manual/Musculoskeletal Medicine Scientific committee. Protocol Formats. 2004;
  15. Deeks JJ. Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests. BMJ. 2001;323:157–162
  16. Irwig L, Macaskill P, Glasziou P, et al. Meta-analytic methods for diagnostic test accuracy. J Clin Epidemiol. 1995;48:119–130
  17. Altman DG. Some common problems in medical research. In:  Altman DG editors. Practical statistics for medical research. London: Chapman & Hall; 1991;p. 396–439
  18. Bigos S, Bowyer O, Braen G, et al. Acute low back problems in adults. Clinical Practice Guideline No. 14. AHCPR Publication No. 95-0642 Rockville (Md): Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services; 1994;[December. Available from:www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.25870.]
  19. Hartvigsen J, Lings S, Leboeuf-Yde C, Bakketeig L. Psychosocial factors at work in relation to low back pain and consequences of low back pain; a systematic, critical review of prospective cohort studies. Occup Environ Med. 2004;61:e2
  20. Pool JJ, Hoving JL, De Vet HC, van Mameren H, Bouter LM. The interexaminer reproducibility of physical examination of the cervical spine. J Manipulative Physiol Ther. 2004;27:84–90
  21. Fjellner A, Bexander C, Faleij R, Strender LE. Interexaminer reliability in physical examination of the cervical spine. J Manipulative Physiol Ther. 1999;22:511–516
  22. Strender LE, Lundin M, Nell K. Interexaminer reliability in physical examination of the neck. J Manipulative Physiol Ther. 1997;20:516–520
  23. Strender LE, Sjoblom A, Sundell K, Ludwig R, Taube A. Interexaminer reliability in physical examination of patients with low back pain. Spine. 1997;22:814–820
  24. Keating JC, Bergmann TF, Jacobs GE, Finer BA, Larson K. Interexaminer reliability of eight evaluative dimensions of lumbar segmental abnormality. J Manipulative Physiol Ther. 1990;13:463–470
  25. Viikari-Juntura E. Interexaminer reliability of observations in physical examinations of the neck. Phys Ther. 1987;67:1526–1532
  26. Sebastian D, Chovvath R. Reliability of palpation assessment in non-neutral dysfunctions of the lumbar spine. Orthop Phys Ther Pract. 2004;16:23–26
  27. Hicks GE, Fritz JM, Delitto A, Mishock J. Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil. 2003;84:1858–1864
  28. Downey B, Nicholas T, Niere K. Can manipulative physiotherapists agree on which lumbar level to treat based on palpation?. Physiotherapy. 2003;89:74–81
  29. Christensen HW, Vach W, Manniche C, Haghfelt T, Hartvigsen L, Høilund-Carlsen PF. Palpation of the upper thoracic spine—an observer reliability study. J Manipulative Physiol Ther. 2002;25:285–292
  30. Horneij E, Hemborg B, Johnsson B, Ekdahl C. Clinical tests on impairment level related to low back pain: a study of test reliability. J Rehabil Med. 2002;34:176–182
  31. Marcotte J, Normand MC, Black P. The kinematics of motion palpation and its effect on the reliability for cervical spine rotation. J Manipulative Physiol Ther. 2002;25:E7
  32. Comeaux Z, Eland D, Chila A, Pheley A, Tate M. Measurement challenges in physical diagnosis: refining interrater palpation, perception and comminication. J Bodyw Mov Ther. 2001;5:245–253
  33. Ghoukassian M, Nicholls B, McLaughlin P. Inter-examiner reliability of the Johnson and Friedman percussion scan of the thoracic spine. J Osteopath Med. 2001;4:15–20
  34. French SD, Green S, Forbes A. Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain. J Manipulative Physiol Ther. 2000;23:231–238
  35. Smedmark V, Wallin M. Inter-examiner reliability in assessing passive intervertebral motion of the cervical spine. Man Ther. 2000;5:97–101
  36. van Suijlekom HA, de Vet HC, van den Berg SG, Weber WE. Interobserver reliability in physical examination of the cervical spine in patients with headache. Headache. 2000;40:581–586
  37. Vincent-Smith B, Gibbons P. Inter-examiner and intra-examiner reliability of standing flexion test. Man Ther. 1999;4:87–93
  38. Hawk C, Phongphua C, Bleecker J, Swank L, Lopez D, Rubley T. Preliminary study of the reliability of assessment procedures for indications for chiropractic adjustments of the lumbar spine. J Manipulative Physiol Ther. 1999;22:382–389
  39. Meijne W, van Neerbos K, Aufdemkampe G, van der Wurff P. Intraexaminer and interexaminer reliability of the Gillet test. J Manipulative Physiol Ther. 1999;22:4–9
  40. Lundberg G, Gerdle B. The relationships between spinal sagittal configuration, joint mobility, general low back mobility and segmental mobility in female homecare personnel. Scand J Rehabil Med. 1999;31:197–206
  41. Cattrysse E, Swinkels RAH, Oostendorp RAB, Duquet W. Upper cervical instability: are clinical tests reliable?. Man Ther. 1997;2:91–97
  42. Jull G, Zito G. Inter-examiner reliability to detect painful upper cervical joint dysfunction. Aust J Physiother. 1997;43:125–129
  43. McPartland JM, Goodridge JP. Counterstrain and traditional osteopathic examination of the cervical spine compared. J Bodyw Mov Ther. 1997;1:173–178
  44. Tuchin P, Hart J, Colman R, Johnson C, Gee A, Edwards I, et al. Interexaminer reliability of chiropractic evaluation for cervical spine problems—a pilot study. Chiropr J Aust. 1996;5:23–29
  45. Haas M. Reliability of manual end-play palpation of the thoracic spine. Chiropr Tech. 1995;7:120–124
  46. Lindsay DM. Interrater reliability of manual therapy assessment techniques. Phys Ther Can. 1995;47:173–180
  47. Binkley J, Stratford PW, Gill C. Interrater reliability of lumbar accessory motion mobility testing. Phys Ther. 1995;75:786–792
  48. Inscoe EL, Witt PL, Gross MT, Mitchell RU. Reliability in evaluating passive intervertebral motion of the lumbar spine. J Man Manip Ther. 1995;3:135–143
  49. Maher C, Adams R. Reliability of pain and stiffness assessments in clinical manual lumbar spine examination. Phys Ther. 1994;74:801–809
  50. Hubka MJ, Phelan SP. Interexaminer reliability of palpation for cervical spine tenderness. J Manip Physiol Ther. 1994;17:591–595
  51. Paydar D, Thiel H, Gemmell H. Intra- and interexaminer reliability of certain pelvic palpatory procedures and the sitting flexion test for sacroiliac joint mobility and dysfunction. J Neuromusculoskel Syst. 1994;2:65–69
  52. Boline PD, Haas M, Meyer JJ, Kassak K, Nelson C, Keating JC. Interexaminer reliability of eight evaluative dimensions of lumbar segmental abnormality: part II. J Manipulative Physiol Ther. 1993;16:363–374
  53. Mior SA, McGregor M, Schut B. The role of experience in clinical accuracy. J Manipulative Physiol Ther. 1990;13:68–71
  54. Leboeuf C. Chiropractic examination procedures: a reliability and consistency study. J Aust Chiropr Assoc. 1989;19:101–104
  55. Herzog W, Read LJ, Conway PJ, Shaw LD, McEwen MC. Reliability of motion palpation procedures to detect sacroiliac joint fixations. J Manipulative Physiol Ther. 1989;12:86–92
  56. Nansel DD, Peneff AL, Jansen RD, Cooperstein R. Interexaminer concordance in detecting joint-play asymmetries in the cervical spines of otherwise asymptomatic subjects. J Manipulative Physiol Ther. 1989;12:428–433
  57. Mootz RD, Keating JC, Kontz HP, Milus TB, Jacobs GE. Intra- and interobserver reliability of passive motion palpation of the lumbar spine. J Manipulative Physiol Ther. 1989;12:440–445
  58. Boline PD. Interexaminer reliability of palpatory evaluations of the lumbar spine. Am J Chiropr Med. 1988;1:5–11
  59. Carmichael JP. Inter- and intra-examiner reliability of palpation for sacroiliac joint dysfunction. J Manipulative Physiol Ther. 1987;10:164–171
  60. Love RM, Brodeur RR. Inter- and intra-examiner reliability of motion palpation for the thoracolumbar spine. J Manipulative Physiol Ther. 1987;10:1–4
  61. Bergstrøm E, Courtis G. An inter- and intra-examiner reliability study of motion palpation of the lumbar spine in lateral flexion in the seated position. Eur J Chiropr. 1986;34:121–141
  62. Mior SA, King R. Intra and interexaminer reliability of motion palpation in the cervical spine. J Can Chiropr Assoc. 1985;29:195–199
  63. Deboer KF, Harmon R, Tuttle CD, Wallace H. Reliability study of detection of somatic dysfunctions in the cervical spine. J Manipulative Physiol Ther. 1985;8:9–16
  64. Potter NA, Rothstein JM. Intertester reliability for selected clinical tests of the sacroiliac joint. Phys Ther. 1985;65:1671–1675
  65. Johnston WL, Allan BR, Hendra JL, Neff DR, Rosen ME, Sills LD, et al. Interexaminer study of palpation in detecting location of spinal segmental dysfunction. J Am Osteopath Assoc. 1983;82:839–845
  66. Gonella C, Paris SV, Kutner M. Reliability in evaluating passive intervertebral motion. Phys Ther. 1982;62:436–444
  67. Wiles MR. Reproducibility and interexaminer correlation of motion palpation findings of the sacroiliac joints. J Can Chiropr Assoc. 1980;24:59–69
  68. Oldreive WL. Manual therapy rounds. A critical review of the literature on tests of the sacroiliac joint. J Man Manip Ther. 1995;3:157–161
  69. Keating JC. Inter-examiner reliability of motion palpation of the lumbar spine: a review of quantitative literature. Am J Chiropr Med. 1989;2:107–110
  70. Panzer DM. The reliability of lumbar motion palpation. J Manipulative Physiol Ther. 1992;15:518–524
  71. Haas M. The reliability of reliability. J Manipulative Physiol Ther. 1991;14:199–208
  72. Humphreys K, Delahaye M, Peterson CK. An investigation into the validity of cervical spine motion palpation using subjects with congenital block vertebrae as a “gold standard”. BMC Musculoskelet Disord. 2004;5:19
  73. van Deursen L, Patijn J, Ockhuysen A, Vortman BJ. The value of some clinical tests of the sacro-iliac joint. Man Med. 1990;5:96–99
  74. Feldt LS, McKee ME. Estimation of the reliability of skill tests. Res Q. 1958;29:279–293
  75. Haas M, Groupp E, Panzer D, Partna L, Lumsden S, Aickin M. Efficacy of cervical endplay assessment as an indicator for spinal manipulation. Spine. 2003;28:1091–1096
  76. Landis JR, Koch GC. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174
  77. Huxley R, Neil A, Collins R. Unravelling the fetal origins hypothesis: is there really an inverse association between birthweight and subsequent blood pressure?. Lancet. 2002;360:659–665
  78. Chan AW, Hrobjartsson A, Haahr MT, Gotzsche PC, Altman DG. Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. JAMA. 2004;291:2457–2465

 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.

PII: S0161-4754(06)00155-2

doi: 10.1016/j.jmpt.2006.06.011

Journal of Manipulative and Physiological Therapeutics
Volume 29, Issue 6 , Pages 475-485.e10 , July 2006

Article Tools

* Image Usage & Resolution