Shaw K Aaron, Dougherty John J, Treffer Kevin D, Glaros Alan G
Kansas City University of Medicine and Biosciences’ College of Osteopathic Medicine, MO, USA.
J Am Osteopath Assoc. 2012 Dec;112(12):775-82. doi: 10.7556/jaoa.2012.112.12.775.
Practitioners of manipulative medicine have long sought to prove the intra- and interexaminer reliability of palpatory examinations in assessing somatic dysfunction. However, decades of research have yet to achieve the level of reproducibility needed to satisfy evidence-based criteria.
To examine the content validity of segmental motion evaluations using ultrasonographic measurements and to investigate the implication of these results for understanding the effects of an osteopathic manipulative treatment technique--high-velocity, low-amplitude (HVLA)--applied to somatic dysfunction in the lumbar spine.
A repeated-measures design was used, with the ultrasonographer blinded to the findings for each participant. The study was divided into 2 phases: (1) palpatory and ultrasonographic examination with no treatment and (2) palpatory and ultrasonographic examination with HVLA treatment. During phase 1, measurements were taken of tissue depth corresponding to bony landmarks of the dysfunctional vertebrae. Dysfunction was identified by means of palpatory examination and captured in sequential (ie, test-retest) ultrasonographic images. Content validity of somatic dysfunction was addressed by comparing palpatory examination with ultrasonographic data. During phase 2, the same protocol for tissue depth measurements was applied to the pre- and posttreatment images for comparison.
Twelve young, healthy, asymptomatic students with no contraindications to HVLA treatment were recruited at Kansas City University of Medicine and Biosciences. The test-retest reliability, as determined by a Pearson correlation coefficient, was 0.997. For all participants, objectively identified side of dysfunction correlated with palpatory evaluation of segmental motion. A within-subjects analysis of variance was performed on the raw data, corrected for lumbar lordosis, showing statistical significance for main effect for side of measurement (P<.001) and interaction of side and time (P<.001), and showed no statistically significant effect for time (P=.259).
Ultrasonography is a reliable instrument for the assessment of somatic dysfunction of the lumbar spine. The data also establish the content validity of palpatory examinations. In addition, this study provides the first objective evidence, to our knowledge, of the effect of a thrusting manipulative treatment on dysfunctional lumbar vertebrae.
长期以来，手法医学从业者一直试图证明触诊检查在评估躯体功能障碍方面的检查者内和检查者间可靠性。然而，数十年的研究尚未达到满足循证标准所需的可重复性水平。
使用超声测量检查节段性运动评估的内容效度，并研究这些结果对于理解应用于腰椎躯体功能障碍的整骨手法治疗技术——高速度、低幅度（HVLA）——效果的意义。
采用重复测量设计，超声检查者对每位参与者的检查结果不知情。该研究分为两个阶段：（1）未经治疗的触诊和超声检查，以及（2）接受HVLA治疗后的触诊和超声检查。在第一阶段，测量与功能障碍椎骨的骨性标志相对应的组织深度。通过触诊检查确定功能障碍，并在连续（即重测）超声图像中记录。通过将触诊检查与超声数据进行比较来探讨躯体功能障碍的内容效度。在第二阶段，将相同的组织深度测量方案应用于治疗前和治疗后的图像进行比较。
在堪萨斯城大学医学与生物科学学院招募了12名年轻、健康、无症状且无HVLA治疗禁忌症的学生。由皮尔逊相关系数确定的重测信度为0.997。对于所有参与者，客观确定的功能障碍侧与节段性运动的触诊评估相关。对原始数据进行了受试者内方差分析，并对腰椎前凸进行了校正，结果显示测量侧的主效应具有统计学意义（P<0.001），测量侧与时间的交互作用具有统计学意义（P<0.001），而时间效应无统计学意义（P=0.259）。
超声检查是评估腰椎躯体功能障碍的可靠工具。这些数据还确立了触诊检查的内容效度。此外，据我们所知，本研究首次提供了推按手法治疗对功能障碍腰椎效果的客观证据。
