Keating J C, Bergmann T F, Jacobs G E, Finer B A, Larson K
Palmer College of Chiropractic/West, Sunnyvale, CA 94087.
J Manipulative Physiol Ther. 1990 Oct;13(8):463-70.
The interexaminer reliability of noninvasive methods of examining lumbar spinal segments is not well established. In this project the interexaminer reliability of three experienced chiropractic examiners, who evaluated 21 symptomatic and 25 asymptomatic subjects, was explored. Eight noninvasive segmental examination strategies (dimensions) were employed at each spinal segment from T11/T12 through L5/S1. Marginal to good agreement beyond chance was noted for palpatory pain over osseous structures and in paraspinal soft-tissues. Weaker and less frequently, significant concordance between examiners was noted for detection of temperature differences (greater than or equal to 1.5 degrees F) between adjacent segments and for visual inspection for segmental abnormality. Little significant agreement between examiner was found for active and passive motion palpation, muscle tension palpation and misalignment palpation. This study suggests that "subjective" findings (pain) may be among the most reliable of conservative spinal observations. Weak but significant correlations were found when positive findings for the eight dimensions at each lumbar segment were summed to form a composite joint abnormality index. When the multidimension index was developed using the four most reliable dimensions, slightly stronger correlations were found. The strongest agreement between examiners tended to be found in the lower lumbar spine.
用于检查腰椎节段的非侵入性方法的检查者间可靠性尚未得到充分证实。在本项目中，探讨了三位经验丰富的整脊检查者对21名有症状和25名无症状受试者进行评估时的检查者间可靠性。从T11/T12至L5/S1的每个脊柱节段均采用了八种非侵入性节段检查策略（维度）。在骨结构和椎旁软组织上的触诊疼痛方面，观察到超出偶然的边缘至良好一致性。对于相邻节段之间温度差异（大于或等于1.5华氏度）的检测以及节段异常的视觉检查，检查者之间的显著一致性较弱且频率较低。在主动和被动运动触诊、肌肉张力触诊和错位触诊方面，检查者之间几乎没有显著一致性。本研究表明，“主观”发现（疼痛）可能是保守性脊柱观察中最可靠的发现之一。当将每个腰椎节段八个维度的阳性发现相加形成综合关节异常指数时，发现了较弱但显著的相关性。当使用四个最可靠的维度制定多维度指数时，发现相关性稍强。检查者之间最强的一致性往往出现在下腰椎。
