Review of methods used by chiropractors to determine the site for applying manipulation

Background: With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. Methods: Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation. Results: A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement. Conclusions: A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.https://doi.org/10.1186/2045-709X-21-3

Influência da resolução e da distância da câmera nas medidas feitas pelo software de avaliação postural (sapo)

O erro na medida de um sistema de avaliação da postura está relacionado com a digitalização, a resolução da câmera, a distância da câmera em relação ao voluntário estudado, entre outros. Estes erros somam-se no procedimento metodológico e muitos deles não são possíveis evitar, porém devem ser conhecidos e quantificados. OBJETIVO: Quantificar o erro na medida realizada pelo SAPO (Software para avaliação postural) em diferentes situações experimentais. MÉTODOS: Foram realizadas 16 fotos de um manequim de 1,40m articulado nos planos anterior, posterior, lateral direita e lateral esquerda com câmeras de 3,2 e 12,0 megapixels, posicionadas a 3,0m e a 5,0m de distância do manequim. Para a quantificação do erro, foram calculadas as diferenças das medidas obtidas por meio do SAPO com as medidas feitas diretamente no manequim. Apenas um avaliador realizou o registro das imagens, porém a digitalização no software dos pontos demarcados no manequim foi realizada por três digitalizadores, sendo dois inexperientes e um experiente. RESULTADOS: Os valores médios das medidas horizontais, verticais, angulares e de distância são próximos de zero, embora algumas variáveis angulares apresentem valores maiores, como nas medidas de ângulo Q direito e esquerdo. A câmera com resolução de 3,2 megapixels posicionada a 3m apresentou o menor erro. CONCLUSÃO: O SAPO é um método acurado para uso clínico; são necessários estudos para verificar a influência do plano de posicionamento do voluntário em relação à câmera, o efeito do reposicionamento e da palpação nas medidas oferecidas pelo software