Inter-examiner reliability of four static palpation tests used for assessing pelvic dysfunction

Area of Science:

• Osteopathic manipulative medicine
• Clinical biomechanics
• Musculoskeletal assessment

Background:

• Palpation is crucial in muscle energy technique (MET) for identifying asymmetry and guiding interventions.
• Reliable palpation is essential for consistent and effective clinical practice.

Purpose of the Study:

• To evaluate the inter-examiner reliability of static palpation for specific anatomical landmarks.
• To assess the utility of palpation in detecting asymmetry for MET interventions.

Main Methods:

• Two experienced physiotherapists independently palpated L5 transverse processes, sacral sulci, inferior lateral angles of the sacrum, and medial malleoli.
• Twenty-five participants with low back and/or sacroiliac pain were examined.
• Inter-examiner reliability was quantified using observed agreement and kappa coefficients.

Main Results:

• Low inter-examiner reliability was found for L5, sacral sulci, and inferior lateral angles (kappa coefficients 0.11-0.17).
• Moderate reliability was observed for medial malleoli palpation (kappa coefficient 0.28).
• Observed agreement ranged from 40-52% across the assessed landmarks.

Conclusions:

• Static palpation of these landmarks demonstrates poor to moderate inter-examiner reliability in a clinical setting.
• Variations in palpation technique likely contribute to the low reliability.
• The clinical utility of these specific palpation tests for asymmetry detection and intervention selection is questionable.