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Example Reliability Study

Example Reliability Study. Interexaminer Reliability of Palpation for Cervical Spine Tenderness Hubka & Phelan JMPT 1994; (17)9. Background. Manual palpation is commonly used for examination of the musculoskeletal system It is considered an important procedure for deciding where to manipulate

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Example Reliability Study

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  1. Example Reliability Study Interexaminer Reliability of Palpation for Cervical Spine Tenderness Hubka & Phelan JMPT 1994; (17)9

  2. Background • Manual palpation is commonly used for examination of the musculoskeletal system • It is considered an important procedure for deciding where to manipulate • Unfortunately, many diagnostic palpation methods have not been found to be valid or reliable

  3. Background Cont. • Including motion palpation and static palpation for vertebral misalignment • Palpation for tenderness has good to excellent reliability for examination of the lumbar spine • It is frequently used to identify the source of pain and target of spinal manipulation

  4. Purpose • To report the interexaminer reliability of palpation for cervical spine tenderness in neck pain patients

  5. Methods • Thirty patients with neck pain (the sample) were recruited from a private chiropractic practice (the population) • Inclusion criteria • Experiencing unilateral neck pain diagnosed as being mechanical* *Pain aggravated by movement, relieved by rest and not associated with serious underlying pathology

  6. Methods Cont. • Exclusion criteria • Patients with nonmechanical or undiagnosed neck pain • Subjects were informed of the study and consented to participate • Two chiropractors independently evaluated each of the 30 patients

  7. Methods Cont. • Marks were placed on the skin overlying the C2 and C7 spinous processes • The examiners palpated with their second through fourth fingertips, with their middle fingertip directly over the skin mark • There was no attempt to standardize the amount of pressure applied by each examiner

  8. Methods Cont. • The first examiner pressed over each skin mark and asked the patient to indicate which spot was the most tender • The second examiner, blinded to the findings of the first examiner, repeated the palpation examination • The order of the examiners was randomly varied

  9. Statistical Analysis • Interexaminer reliability was tested with a within-subjects (repeated measures) design • Agreement between examiners on the most tender spinal segment was calculated using kappa (K), percent agreement, and standard error (SE)

  10. Results • Descriptive statistics • 19 females and 11 males • Average age (SD) of 39.4 (14.6) yr (range = 21-78 yr). • Mean duration of pain (SD) was 21 (26.4) months (range = 2 days-2 yr) • Interexaminer reliability was found to be good (K = .68, p < .001).

  11. Perfect agreement would line up along the diagonal Results Cont.

  12. Results Cont.

  13. Limitations • The possibility exists that error occurred while locating and numbering the posterior joints; therefore, the reported frequency of intervertebral joint tenderness may be inaccurate • The examiners used different amounts of pressure. However, they obtained a high level of agreement, suggesting that palpation for tenderness is easy to use

  14. Conclusion • Manual palpation for cervical spine tenderness is highly reliable and simple to use in practice • It is also accurate for the diagnosis of cervical spine posterior joint syndrome

  15. Reliability/Validity Critical Appraisal Check Sheet • Were the methods of performance for the procedure adequately described? Y _ • Was the proposed purpose or use of the test described? Y _ • Were subjects with and without the disorder included in the methods? _ N • Was the study population appropriate for evaluating the proposed use of the test? Y _ • Were the inclusion and exclusion criteria described? Y _ • Was an appropriate sample size considered? _ N

  16. Were demographic and clinical characteristics of subjects described? Y _ • Was a normal/abnormal test value defined? Y _ • Was there enough detail to the data to calculate appropriate results? Y _ • Was an appropriate gold standard used? _ _ • Were predictive values used correctly? _ _ • Was the test applied in manner replicating clinical practice? Y _ • Do the benefits of this study outweigh the flaws? Y _ • What are some additional questions that I should ask before I use this diagnostic test/procedure? • The authors indicated that the posterior intervertebral joint was the problem. Could other tissues be involved in a tender patient? • Does this mean that I should adjust this segment?

  17. Figure 1

  18. Figure 2

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