Validity and reliability of spinal palpation: systematic review

Najm WI¹, Seffinger MA², Mishra SI³, Dickerson VM¹, Reinsch S¹, Murphy LS¹, Adams A⁴

¹University of California, Irvine, Orange, California, USA

²College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA

³University of Maryland, Baltimore, Maryland, USA

⁴Florida State University, Tallahassee, Florida, USA

Objective

To assess the reliability and validity of spinal palpatory procedures used to diagnose spinal somatic dysfunction.

Materials and methods

Electronic and manual databases were searched for articles published between 1996 and 2001. A quality assessment instrument was developed and standardised, articles were randomly assigned to two blinded, independent examiners and scored. Forty-nine out of 797 articles on reliability and five validity articles met the inclusion criteria.

Results

Reliability: Higher quality studies showed acceptable reliability for (i) inter-examiner regional range of motion of the cervical spine, (ii) intra-examiner thoracic and lumbar segmental vertebral motion tests and (iii) inter-examiner pain provocation at L4-L5 and L5-S1, lumbar paraspinal myofascial trigger points (between trained examiners only), cervical spine, and at T1 and the sternocleidomastoid muscle. Examiners’ discipline, experience level, consensus on procedure used, training prior to the study or use of symptomatic subjects do not improve reliability.

Validity: Motion studies used a mechanical model as a reference standard. Examiners were more accurate at identifying mobile as opposed to immobile spinal segments. The range of motion assessment has poor sensitivity regardless of the examiner’s experience. Pain studies used the subjects’ own report as a reference standard. Sensitivity for cervical pain assessment was 82%.

Conclusion

The quality of the published studies on the reliability and validity of spinal palpation needs to be improved. Soft tissue and segmental motion tests have not been shown to be either reliable or valid. Pain provocation tests are mostly reliable and demonstrate higher sensitivity.

Acknowledgements

This project was supported by a grant from UC Irvine College of Medicine 41^st Trust. The work was done at the Susan Samueli Center for Complementary and Alternative Medicine, University of California at Irvine, California, USA.

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