Snider Eric J, Pamperin Kenneth, Johnson Jane C, Shurtz Natalie R, Degenhardt Brian F
From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri.
J Am Osteopath Assoc. 2014 Jun;114(6):460-9. doi: 10.7556/jaoa.2014.096.
Although spinal somatic dysfunction diagnosis is taught at all colleges of osteopathic medicine, few objective measures have been used to evaluate student accuracy.
To assess the palpatory skills of osteopathic medical students in evaluating positional asymmetry in the transverse plane using static block transverse process and lumbar spine models.
For this observational study, first-year osteopathic medical students completed 3 palpatory assessments using uncovered and covered block transverse process and lumbar spine models to simulate a range of positional asymmetries of the transverse processes. With use of logistic regression, 80%, 90%, and 95% thresholds were defined as the magnitude of asymmetry for which the predicted probability of students correctly determining the direction of asymmetry exceeded a specified amount (.80, .90, or .95).
A total of 346 students completed the assessments. For the uncovered block transverse process model (assessment 1), students correctly identified the direction of asymmetry with .89 probability at 1 mm of asymmetry (80% threshold), .94 probability at 2 mm (90% threshold), and .95 probability at 3 mm (95% threshold). For the covered block transverse process model, students correctly identified the direction of asymmetry with .80 probability at 1 mm (80% threshold), .92 probability at 2 mm (90% threshold), and .98 probability at 3 mm (95% threshold) by the third assessment. For the uncovered lumbar spine model (assessment 2), students correctly identified the direction of asymmetry with .93 probability at 2 mm (80% and 90% thresholds) and .95 probability at 3 mm (95% threshold). For the covered lumbar spine model (assessments 2 and 3), students correctly identified the direction of asymmetry with .87 probability at 4 mm (80% threshold); 90% and 95% thresholds were not reached with the range of asymmetries tested.
Most first-year osteopathic medical students were able to discern the direction of positional asymmetry of transverse processes on static models. Depending on the model type, student performance improved (block transverse process models) or declined (lumbar spine models) over time. Future studies should evaluate whether accuracy of palpating lumbar spine models translates to accuracy of palpating human lumbar spines.
尽管所有整骨医学院校都教授脊柱躯体功能障碍诊断，但很少有客观方法用于评估学生的诊断准确性。
使用静态块状横突和腰椎模型评估整骨医学专业学生在评估横断面位置不对称方面的触诊技能。
在这项观察性研究中，一年级整骨医学专业学生使用未覆盖和覆盖的块状横突及腰椎模型完成了3次触诊评估，以模拟横突的一系列位置不对称情况。通过逻辑回归，将80%、90%和95%的阈值定义为不对称程度，即在此程度下学生正确判断不对称方向的预测概率超过指定值（0.80、0.90或0.95）。
共有346名学生完成了评估。对于未覆盖的块状横突模型（评估1），学生在不对称1毫米时正确识别不对称方向的概率为0.89（80%阈值），在2毫米时为0.94（90%阈值），在3毫米时为0.95（95%阈值）。对于覆盖的块状横突模型，到第三次评估时，学生在不对称1毫米时正确识别不对称方向的概率为0.80（80%阈值），在2毫米时为0.92（90%阈值），在3毫米时为0.98（95%阈值）。对于未覆盖的腰椎模型（评估2），学生在不对称2毫米时正确识别不对称方向的概率为0.93（80%和90%阈值），在3毫米时为0.95（95%阈值）。对于覆盖的腰椎模型（评估2和3），学生在不对称4毫米时正确识别不对称方向的概率为0.87（80%阈值）；在所测试的不对称范围内未达到90%和95%的阈值。
大多数一年级整骨医学专业学生能够在静态模型上辨别横突位置不对称的方向。根据模型类型，随着时间推移，学生表现有所提高（块状横突模型）或下降（腰椎模型）。未来研究应评估腰椎模型触诊的准确性是否能转化为人体腰椎触诊的准确性。
