Boline P D, Haas M, Meyer J J, Kassak K, Nelson C, Keating J C
Northwestern College of Chiropractic, Bloomington, MN 55431-1599.
J Manipulative Physiol Ther. 1993 Jul-Aug;16(6):363-74.
The objectives of this study were to assess the interexaminer agreement of palpation for soft tissue and osseous pain along with visual observations in the lumbar spine. Second, the interexaminer agreement of dermothermograph and surface electromyographic (EMG) scans of the lumbar spine were assessed. Third, to perform these evaluations on symptomatic low back patients. Finally, the most reliable measurements were combined in a multidimensional index of segmental lumbar abnormality, which was assessed for interexaminer agreement.
This is an interexaminer reliability study of commonly used palpatory and instrumentation procedures used to assess lumbar segmental abnormality.
This study was conducted at Pain Assessment and Rehabilitation Center (PARC) and the Center for Clinical Studies (CCS) at Northwestern College of Chiropractic.
The patients involved in this study were symptomatic at the time of examination. The patients were recruited from the CCS clinic and PARC.
Palpation for osseous pain produced kappa coefficients ranging from .48-.90. Palpation for soft tissue pain produced kappa coefficients that ranged from .40-.79 and the kappas for visual observation ranged from .34-.84. The dermothermograph and surface EMG scanner were also assessed with the kappa coefficient for their reliability in assessing lumbar segmental abnormality. The kappa coefficients ranged from -.13 to .59 for the surface EMG and 0- .63 for the dermothermograph measurements. Intraclass correlation coefficients for the surface EMG measurements ranged from .20-.55 and the dermothermograph measurements ranged from .01-.55. Palpation for pain (osseous and soft tissue) and visual observation were included in the multidimensional index of abnormality. The interexaminer agreement of detecting a manipulable lesion was evaluated by designating a lesion present with a positive two out of three tests. Kappa coefficients for the multidimensional index of lumbar abnormality ranged from a low of .05 to a high of .52.
Palpation for pain (osseous and soft tissue) and visual observation produced good to excellent interexaminer agreement and were included in the multidimensional index of abnormality. The interexaminer agreement of surface EMG scans and dermothermograph measurements were poor and considered to be clinically unacceptable, thus were not included in the multidimensional index. Palpation for pain is the only spinal assessment procedure to show consistent reliability in a number of studies.
本研究的目的是评估腰椎软组织和骨疼痛触诊以及视觉观察的检查者间一致性。其次，评估腰椎皮肤温度记录和表面肌电图（EMG）扫描的检查者间一致性。第三，对有症状的下背部患者进行这些评估。最后，将最可靠的测量结果组合成腰椎节段异常的多维指数，并评估其检查者间一致性。
这是一项关于用于评估腰椎节段异常的常用触诊和仪器检查程序的检查者间可靠性研究。
本研究在西北整脊学院的疼痛评估与康复中心（PARC）和临床研究中心（CCS）进行。
参与本研究的患者在检查时均有症状。患者从CCS诊所和PARC招募。
骨疼痛触诊的kappa系数范围为0.48 - 0.90。软组织疼痛触诊的kappa系数范围为0.40 - 0.79，视觉观察的kappa系数范围为0.34 - 0.84。还评估了皮肤温度记录和表面EMG扫描仪在评估腰椎节段异常方面的可靠性kappa系数。表面EMG的kappa系数范围为 - 0.13至0.59，皮肤温度记录测量的kappa系数范围为0至0.63。表面EMG测量的组内相关系数范围为0.20 - 0.55，皮肤温度记录测量的组内相关系数范围为0.01 - 0.55。疼痛（骨和软组织）触诊和视觉观察被纳入异常多维指数。通过指定三项测试中有两项为阳性表示存在病变来评估检测可手法治疗病变的检查者间一致性。腰椎异常多维指数的kappa系数范围从低至0.05到高至0.52。
疼痛（骨和软组织）触诊和视觉观察产生了良好到优秀的检查者间一致性，并被纳入异常多维指数。表面EMG扫描和皮肤温度记录测量的检查者间一致性较差，被认为在临床上不可接受，因此未被纳入多维指数。疼痛触诊是多项研究中唯一显示出一致可靠性的脊柱评估程序。
