Choi Kyung-Eun, Grünert Jan, Werner Marc, Cramer Holger, Anheyer Dennis, Dobos Gustav, Saha Felix J
Brandenburg Medical School Theodor Fontane, Neuruppin, Center for Health Services Research, Berlin, Germany.
Health Services Research, Research Center Medical Imaging and Artificial Intelligence, Danube Private University, Krems, Austria.
Complement Med Res. 2024;31(4):359-366. doi: 10.1159/000539230. Epub 2024 May 14.
Neck reflex points or Adler-Langer points are commonly used in neural therapy to detect so-called interference fields. Chronic irritations or inflammations in the sinuses, teeth, tonsils, or ears are supposed to induce tension and tenderness of the soft tissues and short muscles in the upper cervical spine. The individual treatment strategy is based on the results of diagnostic Adler-Langer point palpation. This study investigated the inter- and intra-rater reliability and explored treatment effects.
We performed a randomized controlled trial with 104 inpatients (80.8% female, 51.8 ± 12.74 years) of a German department for internal and integrative medicine. Patients were randomized to individual neural therapy according to the pathological findings (n = 48) or no treatment (n = 56). In each patient, three experienced raters (20-45 years of experience in neural therapy) and two novice raters (medical students) rated Adler-Langer points rigidity on a standardized rating scale ("strong," "weak," "none"). The patients independently evaluated the tenderness on palpation of the eight points using the same scale. Pressure pain thresholds were assessed at the eight Adler-Langer points. All patients were retested after 30 min. The five raters were blinded to treatment allocation and assessments of the other raters. Video recordings were obtained to assess the consistency of the areas tested by the different raters.
Agreement between patients and raters (Cohen's kappa = 0.161-0.400) and inter-rater reliability were low (Fleiss kappa = 0.132-0.150). Moreover, the individual agreement (pre-post comparisons in untreated patients) was similarly low even in experienced raters (Cohen's kappa = 0.099-0.173). Video documentation suggests that raters do not place their fingers in the correct segments (percentage of correct position: 42.0-60.6%). Pressure pain thresholds at five of the eight Adler-Langer points showed significant changes after treatment compared to none in the control group.
Under this artificial experimental setting, this method of Adler-Langer point palpation has not proven to be a reliable diagnostic tool. But it could be shown that, as claimed by the method, the tenderness in five of eight Adler-Langer points decreased after neural therapy.
颈部反射点或阿德勒 - 兰格点在神经疗法中常用于检测所谓的干扰场。鼻窦、牙齿、扁桃体或耳朵的慢性刺激或炎症被认为会导致上颈椎软组织和短肌的紧张和压痛。个体治疗策略基于阿德勒 - 兰格点触诊的诊断结果。本研究调查了评估者间和评估者内的可靠性，并探索了治疗效果。
我们对德国一家内科与综合医学科室的104名住院患者（女性占80.8%，年龄51.8±12.74岁）进行了一项随机对照试验。根据病理结果将患者随机分为接受个体神经疗法组（n = 48）或不治疗组（n = 56）。在每位患者中，三名经验丰富的评估者（有20 - 45年神经疗法经验）和两名新手评估者（医学生）使用标准化评分量表（“强”、“弱”、“无”）对阿德勒 - 兰格点的僵硬程度进行评分。患者使用相同量表独立评估八个点触诊时的压痛情况。在八个阿德勒 - 兰格点评估压力痛阈值。所有患者在30分钟后重新进行测试。五名评估者对治疗分配和其他评估者的评估结果不知情。获取视频记录以评估不同评估者测试区域的一致性。
患者与评估者之间的一致性（科恩kappa系数 = 0.161 - 0.400）以及评估者间的可靠性较低（弗莱iss kappa系数 = 0.132 - 0.150）。此外，即使在经验丰富的评估者中，个体一致性（未治疗患者治疗前后比较）同样较低（科恩kappa系数 = 0.099 - 0.173）。视频记录表明评估者未将手指放在正确的节段（正确位置的百分比：42.0 - 60.6%）。与对照组无变化相比，八个阿德勒 - 兰格点中的五个点在治疗后的压力痛阈值有显著变化。
在这种人为的实验环境下，这种阿德勒 - 兰格点触诊方法尚未被证明是一种可靠的诊断工具。但可以表明，正如该方法所声称的，在神经疗法后，八个阿德勒 - 兰格点中的五个点的压痛减轻了。
