Inter-examiner Reliability of Lumbar Palpation

Reference:Schneider M, Erhard R, Brach J, Tellin W, Imbarlina F, Delitto A. Spinal palpation for lumbar segmental mobility and pain provocation: an interexaminer reliability study. J Manipulative Physiol Ther. 2008 Jul-Aug;31(6):465-73.

The purpose of this study was to determine the degree of inter-examiner reliability using 2 experienced clinicians performing 3 palpation procedures on patients with a recent history of low back pain.

The clinicians were blinded to each other’s findings and completed the palpation tests on the same day.

Basic Results: The kappa values for palpation of segmental motion restriction were poor and in many cases even less than chance observation (negative kappa values). However, palpation for segmental pain provocation showed fair to good reliability.

Conclusion: Palpation methods to find segmental motion restriction of the lumbar spine are not reliable, however palpation methods used to provoke pain responses are more reliable.

Clinical Relevance: When you press on the L1-L5 spinous processes better resist the temptation to judge it as mildly hyper-mobile or moderately hypo-mobile. The best we can do is say, L4-5 is tender to palpation …that?s all!

Posted on: January 19, 2012

Categories: Lumbar Spine

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