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Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements

PainSci » bibliography » Wirth-Pattullo et al 1994
Tags: controversy, massage, diagnosis, debunkery, manual therapy, treatment

Three articles on PainSci cite Wirth-Pattullo 1994: 1. Does Craniosacral Therapy Work?2. Is Diagnosis for Pain Problems Reliable?3. Palpatory Pareidolia & Diagnosis by Touch

PainSci commentary on Wirth-Pattullo 1994: ?This page is one of thousands in the 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 wherever possible.

The first test of the claim that craniosacral therapists are able to palpate change in cyclical movements of the cranium. They concluded that “therapists were not able to measure it reliably,” and that “measurement error may be sufficiently large to render many clinical decisions potentially erroneous.” They also questioned the existence of craniosacral motion and suggested that CST practitioner might be imagining such motion. This prompted extensive and emphatic rebuttal from Upledger.

~ Paul Ingraham

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 AND PURPOSE: The evaluation of craniosacral motion is an approach used by physical therapists and other health professionals to assess the causes of pain and dysfunction, but evidence for the existence of this motion is lacking and the reproducibility of the results of this palpatory technique has not been studied. This study examined the interexaminer reliability of craniosacral rate and the relationships among craniosacral rate and subjects' and examiners' heart and respiratory rates.

SUBJECTS: Participants were 12 children and adults with histories of physical trauma, surgery, or learning disabilities. Three physical therapists with expertise in craniosacral therapy were the examiners.

METHODS: One of three nurses recorded heart and respiratory rates of both subject and examiner. The examiner then palpated the subject to determine craniosacral rate and reported the findings to the nurse. Each subject was examined by each of the three examiners.

RESULTS: Reliability was estimated using a repeated-measures analysis of variance and the intraclass correlation coefficient (2,1). Significant differences among examiners and the scatter plot of rates showed lack of agreement among examiners. The ICC was -.02. The correlations between subject craniosacral rate and subject and examiner heart and respiratory rates were analyzed with Pearson correlation coefficients and were low and not statistically significant. DISCUSSION AND

CONCLUSIONS: Measurements of craniosacral motion did not appear to be related to measurements of heart and respiratory rates, and therapists were not able to measure it reliably. Measurement error may be sufficiently large to render many clinical decisions potentially erroneous. Further studies are needed to verify whether craniosacral motion exists, examine the interpretations of craniosacral assessment, determine the reliability of all aspects of the assessment, and examine whether craniosacral therapy is an effective treatment.

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