Palpation of the upper thoracic spine: an observer reliability study

Area of Science:

• Chiropractic
• Orthopedics
• Spinal Biomechanics

Background:

• Assessing spinal biomechanic dysfunction is crucial in chiropractic care.
• Reliability of palpation techniques is essential for accurate diagnosis and treatment planning.

Purpose of the Study:

• To evaluate the intraobserver and interobserver reliability of three palpation procedures for detecting spinal biomechanic dysfunction in the upper thoracic spine.
• To compare the reliability of sitting motion palpation, prone motion palpation, and paraspinal palpation for tenderness.

Main Methods:

• A repeated-measures design was employed.
• Two chiropractors participated in interobserver reliability tests, while one chiropractor conducted intraobserver tests.
• Three palpation methods were used: sitting motion palpation, prone motion palpation, and paraspinal palpation for tenderness, with each segment rated as 'absent' or 'present'.

Main Results:

• Intraobserver reliability (hour-to-hour and day-to-day) was good for all three palpation procedures, with kappa values ranging from 0.59 to 0.77.
• Interobserver reliability was good for paraspinal palpation for tenderness (kappa values 0.67-0.70).
• Interobserver reliability was unacceptably poor for prone and sitting motion palpation (kappa values 0.24-0.22).

Conclusions:

• All three palpation procedures demonstrate good intraobserver reliability for assessing thoracic spine dysfunction.
• Paraspinal palpation for tenderness shows good interobserver reliability.
• Motion palpation techniques (sitting and prone) exhibit poor interobserver reliability, limiting their use in multi-practitioner settings.