Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark.
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
PLoS One. 2024 May 30;19(5):e0304571. doi: 10.1371/journal.pone.0304571. eCollection 2024.
Clinicians commonly use manual therapy to treat low back pain by palpating the spine to identify the spinous processes. This study aims to evaluate the ability of experienced clinicians to consistently locate the spinous processes from S1 to T12 through palpation. The results will be compared to topographical data representing the lumbar lordosis at baseline and four follow-up time points.
In a prior prospective randomized trial, experienced clinicians used palpation to locate the lumbar spinous processes (S1-T12) and then digitized these locations in three-dimensional space. The same digitizing equipment was then used to continuously collect three-dimensional position data of a wheel that rolled along the back's surface through a trajectory that connected the previously digitized locations of the spinous processes. This process was repeated at 4 days, 1, 4, and 12 weeks. The resulting lordosis trajectories were plotted and aligned using the most anterior point in the lordosis to compare the locations of the spinous processes identified in different trials. This way, spinous palpation points could be compared to surface topography over time. Intra- and interrater reliability and agreement were estimated using intraclass correlations of agreement and Bland-Altman limits of agreement.
Five clinicians palpated a total of 119 participants. The results showed a large degree of variation in precision estimates, with a mean total value of 13 mm (95%CI = 11;15). This precision error was consistent across all time points. The smallest precision error was found at L5, followed by S1 File, after which the error increased superiorly. Intra- and interrater reliability was poor to moderate.
Comparison of palpation results to a topographic standard representing the lumbar lordosis is a new approach for evaluating palpation. Our results confirm the results of prior studies that find palpation of lumbar spinous processes imprecise, even for experienced clinicians.
临床医生通常通过触诊脊柱来识别棘突，从而使用手法治疗来治疗下腰痛。本研究旨在评估经验丰富的临床医生通过触诊从 S1 到 T12 持续定位棘突的能力。结果将与基线和四个随访时间点的腰椎前凸的地形数据进行比较。
在之前的前瞻性随机试验中，经验丰富的临床医生使用触诊来定位腰椎棘突（S1-T12），然后将这些位置数字化到三维空间中。然后，使用相同的数字化设备，连续收集沿背部表面滚动的轮子的三维位置数据，该轨迹连接先前数字化的棘突位置。该过程在 4 天、1 周、4 周和 12 周时重复进行。绘制并对齐所得的前凸轨迹，使用前凸中最靠前的点来比较不同试验中确定的棘突位置。这样，就可以随时间比较棘突触诊点和表面地形。使用组内相关系数和 Bland-Altman 一致性界限来估计内部和内部观察者的可靠性和一致性。
五名临床医生总共触诊了 119 名参与者。结果表明，精度估计存在很大的变化，平均总误差值为 13 毫米（95%置信区间为 11 至 15）。这种精度误差在所有时间点都保持一致。在 L5 处发现最小的精度误差，其次是 S1 文件，之后误差向上增加。内部和内部观察者的可靠性为差到中度。
将触诊结果与代表腰椎前凸的地形标准进行比较是评估触诊的一种新方法。我们的结果证实了先前研究的结果，即即使对于经验丰富的临床医生，触诊腰椎棘突也不精确。
