Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum
Three articles on PainSci cite Moran 2001: (1) The Complete Guide to Neck Pain & Cricks (2) Does Craniosacral Therapy Work? (3) Is Diagnosis for Pain Problems Reliable?
PainSci summary of Moran 2001: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.
“Palpation of a cranial rhythmic impulse (CRI) is a fundamental clinical skill used in diagnosis and treatment” in craniosacral therapy. So, researchers compared the diagnostics methods of “two registered osteopaths, both with postgraduate training in diagnosis and treatment, using cranial techniques, palpated 11 normal healthy subjects.” Unfortunately, they couldn’t agree on much: “interexaminer reliability for simultaneous palpation at the head and the sacrum was poor to nonexistent.” Emphasis mine.
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.
BACKGROUND: A range of health care practitioners use cranial techniques. Palpation of a cranial rhythmic impulse (CRI) is a fundamental clinical skill used in diagnosis and treatment with these techniques. There has been little research establishing the reliability of CRI rate palpation.
OBJECTIVE: This study aimed to establish the intraexaminer and interexaminer reliability of CRI rate palpation and to investigate the "core-link" hypothesis of craniosacral interaction that is used to explain simultaneous motion at the cranium and sacrum.
DESIGN: Within-subjects, repeated-measures design.
SUBJECTS: Two registered osteopaths, both with postgraduate training in diagnosis and treatment, using cranial techniques, palpated 11 normal healthy subjects.
METHODS: Examiners simultaneously palpated for the CRI at the head and the sacrum of each subject. Examiners indicated the "full flexion" phase of the CRI by activating silent foot switches that were interfaced with a computer. Subject arousal was monitored using heart rate. Examiners were blind to each other's results and could not communicate during data collection.
RESULTS: Reliability was estimated from calculation of intraclass correlation coefficients (2,1). Intrarater reliability for examiners at either the head or the sacrum was fair to good, significant intraclass correlation coefficients ranging from +0.52 to +0.73. Interexaminer reliability for simultaneous palpation at the head and the sacrum was poor to nonexistent, ICCs ranging from -0.09 to +0.31. There were significant differences between rates of CRI palpated simultaneously at the head and the sacrum.
CONCLUSIONS: The results fail to support the construct validity of the "core-link" hypothesis as it is traditionally held by proponents of craniosacral therapy and osteopathy in the cranial field.
related content
- “Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements,” V Wirth-Pattullo and K W Hayes, Physical Therapy, 1994.
- “Interrater reliability: the kappa statistic,” Mary L McHugh, Biochem Med (Zagreb), 2012.
- “The measurement of observer agreement for categorical data,” J R Landis and G G Koch, Biometrics, 1977.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Gerhart 2017 Ann Behav Med.
- Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain. Zhou 2020 Sci Rep.
- Association Between Plantar Fasciitis and Isolated Gastrocnemius Tightness. Nakale 2018 Foot Ankle Int.
- No Added Benefit of Combining Dry Needling With Guideline-Based Physical Therapy When Managing Chronic Neck Pain: A Randomized Controlled Trial. Stieven 2020 J Orthop Sports Phys Ther.
- Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Munteanu 2015 Br J Sports Med.