Examiner reliability of a systematic osteopathic musculoskeletal examination model in patients with stroke: results
Alan H Yee1, William J Brooks2,3, Guillermo A Palchik4
1Division of Vascular Neurology, Department of Neurology, University of California Davis School of Medicine, Ambulatory Care Center, Sacramento, CA, USA.
Context:
No study has systematically measured somatic dysfunction (SD) in patients with acute cerebral ischemia or tested the reliability of a new osteopathic diagnostic construct, called the Functional Pathology of the Musculoskeletal System (FPMSS) model. The methodology assesses the musculoskeletal system (MSS) as an integrated organ system, shifting emphasis of examination away from structural/postural malalignment to whole systemic motion and allows quantification, prioritization, and profiling of disproportionate motion imbalances as compared to traditional diagnostic criteria.
Objectives:
This study aims to assess the reliability of a novel, systematic musculoskeletal examination model to identify SD after stroke or transient ischemic attack (TIA) and in healthy participants.
Methods:
Asymptomatic participants and patients admitted with acute brain ischemia were recruited from an academic tertiary referral center to undergo standardized examinations. Participants were anticipated to undergo paired, blinded ratings by two independent raters on the same day. Paired ratings were performed twice in healthy participants (2 weeks apart), once in those with transient cerebral ischemia, and up to three paired instances, 48-72 hours apart, for patients admitted with acute stroke. Each musculoskeletal assessment consisted of 80 unique physical examination tests performed on each participant focusing on specified body regions: innominate, leg, cephalic extremities, spine, hip, and ankles/feet. Diagnostic assessments were performed by passive, specified linkage testing for available motion, and all examiners were required to participate in standardized consensus training of the FPMSS model. The methodology provides a quantifiable scale to measure grades of restricted motion. Inter-rater reliability was estimated by intraclass correlation coefficient (ICC) analysis.
Results:
A total of 120 participants were enrolled (20 healthy controls, 20 with TIA [disease controls], and 80 with ischemic stroke). A total of 246 examinations were performed by seven examiners with 80 unique paired assessments across the three participant groups. Nearly two-thirds of stroke participants had hemiparesis with, on average, moderate degrees of neurologic disability. By the end of the study, acceptable inter-rater reliability was attained with: moderate agreement testing the innominate and leg; good agreement of the cephalic extremities, spine, and hip; as well as excellent agreement among raters with examination of the ankles/feet.
Conclusions:
Examiners achieved acceptable levels of inter-rater reliability applying the FPMSS diagnostic construct in asymptomatic participants and in those with acute cerebral ischemia following standardized consensus training.
