The Use of Objective Data to Improve Interexaminer Reliability

BACKGROUND: In Osteopathic Manipulative Medicine (OMM) and Manual/Musculoskeletal Medicine (MMM), palpatory diagnosis is performed on a regular basis to diagnose somatic dysfunction (SD). This examination requires careful and precise touch coupled with subjective interpretation by individual examiners who may have been trained to evaluate SD through different methods. Interexaminer reliability studies aim to minimize variance by providing quantifiable scientific data to evaluate specific test protocols which can then be taught to practitioners. In a previous PCOM study, two examiners independently diagnosed innominate bone dysfunction lateralized using the ASIS compression test on a large group of subjects. A pressure monitoring system (IsoTOUCH®, Chattanooga TN) has been used in various studies at the PCOM Human Performance & Biomechanics Laboratory (Kuchera, Jean et al 2006 & Kuchera, Vardy et al 2005) to quantify or standardize forces used in palpatory diagnosis or OMM/MMM treatment applications. This study gathered data during the tesing phase of a new and improved model of this system, using the protocol of the previous ASIS interexaminer reliability study. The data collected during standardization of the system was analyzed in the same manner as the previous study to compare the results of interexaminer reliability to results achieved using live data feed for baseline pressure synchronization between examiners

Comparing Inter-Examiner Reliability Levels when Diagnosing Male & Female Innominate Dysfunctions Using a Hemi-Pelvise Compression Lateralization Test and Pelvic Landmark Levels.

BACKGROUND: When diagnosing innominate somatic dysfunctions it may be relevant to recognize that structural, functional, and hormonal differences exist between male and female pelvises. The female pelvis is less massive, ilia are less sloped, and female hormones influence ligamentous tension. Despite these differences, few studies have analyzed gender effects on inter-examiner reliability when using palpatory diagnosis to diagnose innominate dysfunctions. In this study, we hypothesized that interexaminer reliability would be higher in male subjects than in female subjects due cyclic variability of hormonal influence of ligamentous tension in the female pelvis. The kappa (κ) statistic was selected to evaluate inter-examiner reliability as it is designed to eliminate agreement by chance. The agreement scale as proposed by Landis and Koch was used in the evaluation if the κ-value

Effect of Prior Anterior Superior Iliac Spine Compression Testing on Second Assessor Findings: Implications for Inter-Examiner Reliability Testing

BACKGROUND: Osteopathic physicians use palpation to diagnose sacroiliac joint somatic dysfunction (SD) -- including the Anterior Superior Iliac Spine (ASIS) Compression Test for dysfunctional side lateralization. (Literature suggests right-sided lateralization in 80% of asymptomatic individuals). Accurate, reliable tests are crucial however to diagnose SD and kappa (κ) analysis is a gold-standard to determine the degree of interexaminer reliability for tests. Few studies have examined the effect the palpatory examination has on subsequent diagnostic findings and therefore on κ-values

Inter-Examiner Reliability of an Anterior Superior Iliac Spine Compression Test used to Lateralize Pelvic Somatic Dysfunction to the Right Side or Not

BACKGROUND: Osteopathic physicians use a number of palpatory structural examinations to diagnose pelvic somatic dysfunction (SD). They may elect to use the Anterior Superior Iliac Spine (ASIS) Compression Test to lateralize the dysfunctional side. Accurate, reliable tests are crucial to neuromusculoskeletal diagnosis and this study employs the kappa (κ) analysis protocol recommended for assessing interexaminer reliability of manual medicine tests (published by the Fédération Internationale de Médecine Manuelle [FIMM]). κ-values ≥0.40 (moderate agreement) are considered to be acceptable for use in the clinical setting