Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada.
Centre Ostéopathique du Québec, Montréal, Canada.
J Altern Complement Med. 2021 Mar;27(3):263-272. doi: 10.1089/acm.2020.0325. Epub 2021 Jan 4.
The World Health Organization benchmarks for osteopathic training consider cranial osteopathy as an important manual skill. Studies of cranial manual therapy have exhibited poor reliability. The aim of this study was to investigate the inter-rater reliability of the manual mobility tests of the spheno-occipital synchondrosis (SOS), and the temporal, parietal, and frontal bones, as assessed in osteopathic manual therapy. Twenty-one adults were assessed on a single day by three experienced osteopaths using a standard assessment protocol. Before data collection, the osteopaths participated in a consensus training, which included establishing the criteria for identifying a cranial bone mobility restriction; the application of the seven-step palpation method; a pretesting practice; a fine-tuning palpation training; and a calibration period before the assessment of the subjects. Three subjects were assessed simultaneously with the evaluators rotating to assess each subject. The evaluators were blinded to the subject by a curtain, and each other's assessments. Each bone was rated as restricted or not restricted. The authors applied the Landis and Koch classification to describe the magnitude of inter-rater reliability. Moderate reliability was established for a lateral strain of the SOS (Fleiss' generalized kappa 0.48), substantial reliability was established for the other SOS strain patterns (Fleiss' generalized kappa 0.62-0.75), and almost perfect reliability for temporal, parietal, and frontal bone (Fleiss' generalized kappa 0.81-0.96). The results demonstrate consistency when three experienced osteopaths evaluate cranial bone mobility restrictions. The results highlight the importance of consensus training and rigorous methodology in manual therapy reliability studies.
世界卫生组织的骨科学培训基准认为颅骨手法是一项重要的手法技能。颅手法治疗的研究显示出较差的可靠性。本研究旨在调查在骨科学手法治疗中评估蝶枕联合（SOS）及颞骨、顶骨和额骨的手动活动性测试的观察者间可靠性。 21 名成年人在一天内由三位经验丰富的整骨治疗师使用标准评估方案进行评估。在收集数据之前，整骨治疗师参加了共识培训，包括确定颅骨活动性受限的标准；应用七步触诊法；预测试练习；精细触诊训练；以及在评估受试者之前的校准期。三位受试者同时接受评估者的评估，评估者轮流评估每位受试者。评估者通过幕布和彼此的评估对受试者进行盲法评估。每个骨骼均被评定为受限或不受限。作者应用 Landis 和 Koch 分类法来描述观察者间可靠性的幅度。SOS 的横向应变（Fleiss 广义kappa 0.48）具有中度可靠性，其他 SOS 应变模式（Fleiss 广义kappa 0.62-0.75）具有显著可靠性，颞骨、顶骨和额骨（Fleiss 广义kappa 0.81-0.96）具有几乎完美的可靠性。 结果表明，当三位经验丰富的整骨治疗师评估颅骨活动性受限情况时具有一致性。结果强调了在手动治疗可靠性研究中共识培训和严格方法的重要性。
