Beynon Amber M, Hebert Jeffrey J, Walker Bruce F
1School of Health Professions, Murdoch University, 90 South Street, Murdoch, WA 6150 Australia.
2Faculty of Kinesiology, University of New Brunswick, 3 Bailey Drive, Fredericton, NB E3B 5A3 Canada.
Chiropr Man Therap. 2018 Dec 4;26:49. doi: 10.1186/s12998-018-0218-7. eCollection 2018.
Despite widespread use by manual therapists, there is little evidence regarding the reliability of thoracic spine static palpation to test for a manipulable lesion using stiffness or tenderness as diagnostic markers. We aimed to determine the interrater agreement of thoracic spine static palpation for segmental tenderness and stiffness and determine the effect of standardised training for examiners. The secondary aim was to explore expert consensus on the level of segmental tenderness required to locate a "manipulable lesion".
Two experienced chiropractors used static palpation of thoracic vertebrae on two occasions (pragmatic and standardised approaches). Participants rated tenderness on an 11-point numerical pain rating scale (NPRS) and raters judged segmental stiffness based on their experience and perception of normal mobility with the requested outcomes of hypomobile or normal mobility. We calculated interrater agreement using percent agreement, Cohen's Kappa coefficients ( ) and prevalence-adjusted bias-adjusted Kappa coefficients (PABAK). In a preliminary study, an expert panel of 10 chiropractors took part in a Delphi process to identify the level of meaningful segmental tenderness required to locate a "manipulable lesion".
Thirty-six participants (20 female) were enrolled for the reliability study on the 13th March 2017. Mean (SD) age was 22.4 (3.4) years with an equal distribution of asymptomatic ( = 17) and symptomatic (n = 17) participants. Overall, the interrater agreement for spinal segmental stiffness had Kappa values indicating less than chance agreement [ range - 0.11, 0.53]. When adjusted for prevalence and bias, the PABAK ranged from slight to substantial agreement [0.12-0.76] with moderate or substantial agreement demonstrated at the majority of spinal levels (T1, T2 and T6 to T12). Generally, there was fair to substantial agreement for segmental tenderness [Kappa range 0.22-0.77]. Training did not significantly improve interrater agreement for stiffness or tenderness. The Delphi process indicated that an NPRS score of 2 out of 10 identified a potential "manipulable lesion".
Static palpation was overall moderately reliable for the identification of segmental thoracic spine stiffness and tenderness, with tenderness demonstrating a higher reliability. Also, an increased agreement was found within the mid-thoracic spine. A brief training intervention failed to improve reliability.
尽管手动治疗师广泛使用，但关于胸椎静态触诊以僵硬或压痛作为诊断标志物来检测可手法治疗病变的可靠性的证据很少。我们旨在确定胸椎静态触诊对节段性压痛和僵硬的评分者间一致性，并确定对检查者进行标准化培训的效果。次要目的是探讨关于定位“可手法治疗病变”所需的节段性压痛水平的专家共识。
两名经验丰富的脊医分两次（实用方法和标准化方法）对胸椎进行静态触诊。参与者使用11点数字疼痛评分量表（NPRS）对压痛进行评分，评分者根据他们对正常活动度的经验和感知以及活动度降低或正常活动度的预期结果来判断节段性僵硬。我们使用一致百分比、科恩kappa系数（ ）和患病率调整偏差调整kappa系数（PABAK）计算评分者间一致性。在一项初步研究中，由10名脊医组成的专家小组参与了德尔菲法，以确定定位“可手法治疗病变”所需的有意义的节段性压痛水平。
2017年3月13日，36名参与者（20名女性）被纳入可靠性研究。平均（标准差）年龄为22.4（3.4）岁，无症状（ = 17）和有症状（n = 17）的参与者分布均衡。总体而言，脊柱节段性僵硬的评分者间一致性kappa值表明一致性低于随机水平[ 范围 -0.11, 0.53]。在对患病率和偏差进行调整后，PABAK范围从轻微到高度一致[0.12 - 0.76]，在大多数脊柱节段（T1、T2和T6至T12）表现为中度或高度一致。一般来说，节段性压痛的一致性为中等至高度[kappa范围0.22 - 0.77]。培训并未显著提高僵硬或压痛的评分者间一致性。德尔菲法表明，NPRS评分为2分（满分10分）可识别潜在的“可手法治疗病变”。
静态触诊总体上对识别胸椎节段性僵硬和压痛具有中等可靠性，压痛的可靠性更高。此外，在胸椎中部发现一致性增加。简短的培训干预未能提高可靠性。
