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Prior to this study by Seffinger et al, there was no comprehensive systematic review of the literature on the reliability of cervical, thoracic, or lumbar palpatory diagnostic procedures.

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The inclusion criteria for the searches were: (1) articles in any language that pertained to manual spinal palpation; (2) measurements of interexaminer and/or intraexaminer reliability of manual spinal palpation; and (3) peer-reviewed articles, monographs, or dissertations.

Out of 797 primary research articles, 49 (6%) met the inclusion criteria. Based on scientific rigor and reproducibility of research, investigators developed an instrument that assessed (on a scale of 1 to 100) five primary categories: study subjects, examiners, study conditions, data analysis, and results.

Forty-nine studies met the inclusion criteria (N=2113). Instrument-assigned quality assessment scores for these studies ranged from 25 to 79. In the 12 articles with the highest quality ratings, tests for evaluating pain provocation, motion, and landmark location were found to have acceptable reliability as diagnostic tools for assessing patients' back and neck pain. However, the 12 highest quality articles also indicated that the majority of spinal palpatory diagnostic procedures are unreliable, as are soft tissue tests. In addition, these articles suggested that tests of regional range of motion are more reliable than tests of segmental range of motion and that intraexaminer reliability is preferable to interexaminer reliability.

The quality of research on interexaminer and intraexaminer reliability of spinal palpatory diagnostic procedures needs to be improved. Pain provocation tests have the greatest reliability among spinal palpatory diagnostic procedures, and soft tissue paraspinal palpatory diagnostic tests are not reliable.

	Footnotes

 
"The Somatic Connection" highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This new section of JAOA—The Journal of the American Osteopathic Association strives to chronicle the significant increase in published research on manipulative methods in the United States and the renewed interest in manual medicine internationally, especially in Europe.

Designed to inform osteopathic physicians about significant musculoskeletal research being published in journals other than the JAOA, "The Somatic Connection" gives special attention to research articles directly related to the tenets and principles of osteopathic medicine.

With the launch of this new section, the JAOA is focusing on studies that test the efficacy of manipulative methods in a variety of clinical situations. As the section develops, "The Somatic Connection" will include research that explores other aspects of the musculoskeletal system, including the mechanism of chronic pain and interventions other than spinal manipulation.

To identify research articles to feature, the editors of "The Somatic Connection" search multiple electronic databases and assess articles for their scientific validity. As the editors may easily miss important citations in the literature, readers are encouraged to submit scientific reports for consideration to the following editors of "The Somatic Connection": JAOA Associate Editor Felix J. Rogers, DO, at fjrogers{at}aol.com or Michael A. Seffinger, DO, at mseffinger{at}westernu.edu.

Seffinger MA et al. Spine. 2004;29:E413–E425.

Editor's note: Lead author Michael A. Seffinger, DO, is from the Department of Osteopathic Manipulative Medicine at the Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, Calif.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by FJR, Search for Related Content PubMed Articles by FJR,