Department of Osteopathic Manipulative Medicine, Midwesetern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA.
Midwestern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA.
J Osteopath Med. 2021 Oct 13;122(1):31-43. doi: 10.1515/jom-2021-0020.
The thoracic spine is a common area of focus in osteopathic manipulative medicine (OMM) for a variety of conditions. Thoracic spine somatic dysfunction diagnosis is achieved by palpating for asymmetry at the tips of the transverse processes (TPs). Previous studies reveal that instead of following the rule of threes, the TPs of a given thoracic vertebra generally align with the spinous process (SP) of the vertebra above. Ultrasonography has been widely utilized as a diagnostic tool to monitor musculoskeletal conditions; it does not utilize ionizing radiation, and it has comparable results to gold-standard modalities. In the case of thoracic somatic dysfunction, ultrasound (US) can be utilized to determine the location of each vertebral TP and its relationship with the SP. Previous studies have investigated the correlation between OMM and ultrasonography of the cervical, lumbar, and sacral regions. However, there has been no study yet that has compared osteopathic structural examination with ultrasonographic examination of the thoracic vertebral region.
To examine the relationship between osteopathic palpation and ultrasonographic measurements of the thoracic spine by creating a study design that utilizes interexaminer agreement and correlation.
The ClinicalTrials.gov study identifier is NCT04823637. Subjects were student volunteers recruited from the Midwestern University (MWU)-Glendale campus. A nontoxic, nonpermanent marker was utilized to mark bony landmarks on the skin. Two neuromusculoskeletal board-certified physicians (OMM1, OMM2) separately performed structural exams by palpating T2-T5 TPs to determine vertebral rotation. Two sonographers (US1, US2) separately scanned and measured the distance from the tip of the SP to the adjacent TPs of the vertebral segment below. Demographic variables were summarized with mean and standard deviation. Interexaminer agreement was assessed with percent agreement, Cohen's Kappa, and Fleiss' Kappa. Correlation was measured by Spearman's rank correlation coefficient. Recruitment and protocols were approved by the MWU Institutional Review Board (IRB).
US had fair interexaminer agreement for the overall most prominent segmental rotation of the T3-T5 thoracic spine, with Cohen's Kappa at 0.27 (0.09, 0.45), and a total agreement percentage at 51.5%. Osteopathic palpation revealed low interexaminer agreement for the overall most prominent vertebral rotation, with Cohen's Kappa at 0.05 (0.0, 0.27), and 31.8%. Segment-specific vertebral analysis revealed slight agreement between US examiners, with a correlation coefficient of 0.23, whereas all other pairwise comparisons showed low agreement and correlation. At T4, US had slight interexaminer agreement with 0.24 correlation coefficient, and osteopathic palpation showed low interexaminer (OMM1 vs. OMM2) agreement (0.17 correlation coefficient). At T5, there was moderate agreement between the two sonographers with 0.44 (0.27, 0.60) and 63.6%, with a correlation coefficient of 0.57, and slight agreement between OMM1 and OMM2 with 0.12 (0.0, 0.28) and 42.4%, with 0.23 correlation coefficient.
This preliminary study of an asymptomatic population revealed that there is a low-to-moderate interexaminer reliability between sonographers, low-to-slight interexaminer reliability between osteopathic physicians, and low interexaminer reliability between OMM palpatory examination and ultrasonographic evaluation of the thoracic spine.
胸脊柱是整骨疗法中治疗各种疾病的常见部位。通过触诊横突尖端的不对称性来诊断胸脊柱躯体功能障碍。先前的研究表明，横突一般不遵循三进制规则，而是与上方脊椎的棘突对齐。超声检查已广泛用于监测肌肉骨骼状况，它不使用电离辐射，并且与金标准模式具有可比的结果。在胸躯体功能障碍的情况下，可以使用超声（US）确定每个椎骨横突的位置及其与棘突的关系。先前的研究已经调查了整骨疗法与颈椎、腰椎和骶骨区域的超声检查之间的相关性。然而，还没有研究比较过整骨结构检查与胸椎区域的超声检查。
通过创建利用检查者间一致性和相关性的研究设计，研究整骨触诊与胸脊柱超声测量之间的关系。
ClinicalTrials.gov 研究标识符为 NCT04823637。研究对象为从中西部大学（MWU）-格兰岱尔校区招募的学生志愿者。使用无毒、非永久性标记物在皮肤上标记骨性标志。两名神经肌肉骨骼认证的医师（OMM1、OMM2）分别通过触诊 T2-T5 横突来确定椎体旋转，进行结构检查。两名超声医师（US1、US2）分别对椎体节段下方相邻的 SP 尖端到横突的距离进行扫描和测量。用均值和标准差总结人口统计学变量。用百分比一致性、Cohen's Kappa 和 Fleiss' Kappa 评估检查者间一致性。用 Spearman 秩相关系数测量相关性。MWU 机构审查委员会（IRB）批准了招募和方案。
US 对 T3-T5 胸脊柱整体最明显的节段旋转具有良好的检查者间一致性，Cohen's Kappa 为 0.27（0.09，0.45），总一致性百分比为 51.5%。整骨触诊对整体最明显的椎体旋转显示出低检查者间一致性，Cohen's Kappa 为 0.05（0.0，0.27），一致性百分比为 31.8%。节段特异性椎体分析显示 US 检查者之间有轻微的一致性，相关系数为 0.23，而其他所有两两比较显示出低一致性和相关性。在 T4 处，US 与 0.24 的相关系数有轻微的检查者间一致性，而 OMM1 与 OMM2 之间的一致性（0.17 相关系数）则较低。在 T5 处，两名超声医师之间有中度的一致性，相关系数为 0.44（0.27，0.60）和 63.6%，0.57 的相关系数，而 OMM1 与 OMM2 之间的一致性则为轻微，相关系数为 0.12（0.0，0.28）和 42.4%。
这项对无症状人群的初步研究表明，超声医师之间存在低到中度的检查者间可靠性，整骨医师之间存在低到轻微的检查者间可靠性，而整骨触诊检查与胸脊柱超声评估之间的检查者间可靠性较低。
