PainSci summary of Wirth-Pattullo 1994?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. ★★★☆☆3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
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.
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.
- “Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum,” R W Moran and P Gibbons, Journal of Manipulative & Physiological Therapeutics, 2001.
- “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.
These three articles on PainScience.com cite Wirth-Pattullo 1994 as a source:
- PS Does Craniosacral Therapy Work? — Craniosacral therapists make big promises, but their methods have failed to pass every fair scientific test of efficacy or plausibility
- PS Is Diagnosis for Pain Problems Reliable? — Reliability science shows that health professionals can’t agree on many popular theories about why you’re in pain
- PS Palpatory Pareidolia & Diagnosis by Touch — Tactile illusions, wishful thinking, and the belief in advanced diagnostic palpation skills in massage and other touchy health care
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:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.