Spinal Palpation for Lumbar Segmental Mobility and Pain Provocation: An Interexaminer Reliability Study
Received 20 August 2007; received in revised form 24 March 2008; accepted 30 March 2008.
Abstract
Objective
This study determined the degree of interexaminer reliability using 2 experienced clinicians performing 3 palpation procedures over the lumbar facet joints and sacroiliac joints.
Methods
The sample consisted of 39 patients with low back pain who had a recent history of low back pain. Two doctors of chiropractic independently examined each of these patients in the prone position with 3 different procedures: (1) springing palpation for pain provocation, (2) springing palpation for segmental mobility testing, and (3) the prone instability test. The doctors were blinded to each other's findings and the patient's clinical status, and performed the examinations on the same day. Standard and adjusted κ values were calculated for each test.
Results
The κ values for palpation of segmental motion restriction were poor (range, −.20 to .17) and in many cases less than chance observation (negative κ values). The prone instability test showed reasonable reliability (κ = .54), and palpation for segmental pain provocation also showed fair to good reliability (κ range, .21 to .73).
Conclusions
Palpation methods that are used to provoke pain responses are more reliable than palpation methods in which the clinician purports to find segmental motion restriction. The prone instability test shows good reliability.
gDepartment Chair of Physical Therapy, University of Pittsburgh, Pittsburgh, Pa
Submit requests for reprints to: Michael Schneider, DC, PhD (c.), 1720 Washington Rd, Suite 201, Pittsburgh, PA 15241
This study was approved by the appropriate scientific review committee and Institutional Review Board at the University of Pittsburgh. Institutional Review Board approval number: 0501147.
ABSTRACT