Example Reliability Study

1
Example Reliability Study

• Interexaminer Reliability of Palpation for
  Cervical Spine Tenderness
• Hubka Phelan JMPT 1994 (17)9

2
Background

• Manual palpation is commonly used for examination
  of the musculoskeletal system
• It is considered an important procedure for
  deciding where to manipulate
• Unfortunately, many diagnostic palpation methods
  have not been found to be valid or reliable

3
Background Cont.

• Including motion palpation and static palpation
  for vertebral misalignment
• Palpation for tenderness has good to excellent
  reliability for examination of the lumbar spine
• It is frequently used to identify the source of
  pain and target of spinal manipulation

4
Purpose

• To report the interexaminer reliability of
  palpation for cervical spine tenderness in neck
  pain patients

5
Methods

• Thirty patients with neck pain (the sample) were
  recruited from a private chiropractic practice
  (the population)
• Inclusion criteria
• Experiencing unilateral neck pain diagnosed as
  being mechanical

Pain aggravated by movement, relieved by rest
and not associated with serious underlying
pathology
6
Methods Cont.

• Exclusion criteria
• Patients with nonmechanical or undiagnosed neck
  pain
• Subjects were informed of the study and consented
  to participate
• Two chiropractors independently evaluated each of
  the 30 patients

7
Methods Cont.

• Marks were placed on the skin overlying the C2
  and C7 spinous processes
• The examiners palpated with their second through
  fourth fingertips, with their middle fingertip
  directly over the skin mark
• There was no attempt to standardize the amount of
  pressure applied by each examiner

8
Methods Cont.

• The first examiner pressed over each skin mark
  and asked the patient to indicate which spot was
  the most tender
• The second examiner, blinded to the findings of
  the first examiner, repeated the palpation
  examination
• The order of the examiners was randomly varied

9
Statistical Analysis

• Interexaminer reliability was tested with a
  within-subjects (repeated measures) design
• Agreement between examiners on the most tender
  spinal segment was calculated using kappa (K),
  percent agreement, and standard error (SE)

10
Results

• Descriptive statistics
• 19 females and 11 males
• Average age (SD) of 39.4 (14.6) yr (range
  21-78 yr).
• Mean duration of pain (SD) was 21 (26.4) months
  (range 2 days-2 yr)
• Interexaminer reliability was found to be good (K
  .68, p lt .001).

11
Results Cont.
12
Results Cont.
13
Limitations

• The possibility exists that error occurred while
  locating and numbering the posterior joints
  therefore, the reported frequency of
  intervertebral joint tenderness may be inaccurate
  
• The examiners used different amounts of pressure.
  However, they obtained a high level of agreement,
  suggesting that palpation for tenderness is easy
  to use

14
Conclusion

• Manual palpation for cervical spine tenderness is
  highly reliable and simple to use in practice
• It is also accurate for the diagnosis of cervical
  spine posterior joint syndrome

15
Reliability/Validity Critical Appraisal Check
Sheet

• Were the methods of performance for the procedure
  adequately described? Y _
• Was the proposed purpose or use of the test
  described? Y _
• Were subjects with and without the disorder
  included in the methods? _ N
• Was the study population appropriate for
  evaluating the proposed use of the test? Y _
• Were the inclusion and exclusion criteria
  described? Y _
• Was an appropriate sample size considered? _ N

16

• Were demographic and clinical characteristics of
  subjects described? Y _
• Was a normal/abnormal test value defined? Y _
• Was there enough detail to the data to calculate
  appropriate results? Y _
• Was an appropriate gold standard used? _ _
• Were predictive values used correctly? _ _
• Was the test applied in manner replicating
  clinical practice? Y _
• Do the benefits of this study outweigh the flaws?
  Y _
• What are some additional questions that I should
  ask before I use this diagnostic test/procedure?
  
• The authors indicated that the posterior
  intervertebral joint was the problem. Could other
  tissues be involved in a tender patient?
• Does this mean that I should adjust this segment?

17
Figure 1
18
Figure 2