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Examiners could not find the same problems using spinal motion palpation

PainSci » bibliography » Walker et al 2015
updated
Tags: diagnosis, bad news, spinal adjustment, back pain, neck, spine, treatment, pain problems, head/neck

Three articles on PainSci cite Walker 2015: 1. The Complete Guide to Neck Pain & Cricks2. Does Spinal Manipulation Work?3. Is Diagnosis for Pain Problems Reliable?

PainSci notes on Walker 2015:

Two examiners, using standard methods of motion palpation of the thoracic spine, could not agree well on the location of joint stiffness or pain in a couple dozen patients. Simplifying the diagnostic challenge did not improve matters. Therefore, “The results for interrater reliability were poor for motion restriction and pain.” This does not bode well for manual therapists who use motion palpation to identify patients who might benefit from spinal manipulation.

The study only used two examiners, which might be a serious flaw. More raters would certainly be better. Nevertheless, even a small data sample can produce meaningful information if the effect size is robust enough (any two people can agree on, say, fire hydrant locations; see It's the effect size, stupid), which it probably is here. Even just two examiners should generate more similar results, unless someone is grossly incompetent. If they differ greatly, more examiners probably isn’t going to change that.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

INTRODUCTION: Manual therapists commonly use assessments of intervertebral motion to determine the need for spinal manipulation, but the reliability of these procedures demonstrates conflicting results. The objectives of this study were to investigate the interrater reliability of thoracic spine motion palpation for perceived joint restriction and pain.

METHODS: Twenty-five participants between the ages of 18 and 70, with or without mid-back pain, were enrolled. Two raters motion palpated marked T5–T12 levels using two methods (standardised and pragmatic) and noted any restricted or painful segments. We calculated agreement between two raters by generating raw agreement percentages and Kappa coefficients with 95% confidence intervals.

RESULTS: There was poor to low level of agreement between the raters for both joint stiffness and pain localization using both pragmatic and standardized approaches. The results did not improve significantly when we conducted a post hoc analysis where three spinal levels were collapsed as one and right and left sides were also combined.

CONCLUSIONS: The results for interrater reliability were poor for motion restriction and pain. These findings may have unfavourable implications for all manual therapists who use motion palpation to select patients appropriate for spinal manipulation.

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