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Assessing Palpation Thresholds Using Static Lumbar Spine Models
Snider, E. J. [22]
Pamperin, K. L. [2]
Johnson, J. C. [64]
Shurtz, N. R. [3]
Degenhardt, B. F. [52]

Journal: The Journal of the American Osteopathic Association Date: 2012/08, 112(8):Pages: 534-535. doi: Subito , type of study: observational study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2012.112.8.529/html)

Keywords:

clinical competence [224]
diagnosis [399]
lumbar spine [62]
medical students [659]
observational study [228]
osteopathic medicine [2055]
palpation [215]
USA [1707]

Abstract:

Background: Spinal diagnosis is taught at all colleges of osteopathic medicine. Objective: In this observational study, static models of transverse processes were used to objectively assess students' ability to discern rotational asymmetry through palpation. Methods: First-year osteopathic medical students completed 3 palpatory assessments that included foam-covered and uncovered static lumbar models. Block transverse process models simulated asymmetries of the transverse processes (range, 1-6 mm) using blocks of different heights. For the lumbar spine models, bronze vertebrae were secured to a wooden base; the magnitude of the asymmetry (range, 2-6 mm) was the difference in the heights of the right and left transverse processes. For all models, students were asked to determine whether the right side of the model was anterior or posterior relative to the left side. Using logistic regression, thresholds were defined as the magnitude of asymmetry where the predicted probability of correctly determining the direction of asymmetry exceeded a specified amount (.80, .90, or .95). The local institutional review board approved the study. Results: A total of 346 students completed the assessments. In the uncovered block transverse process model (assessment 1), students correctly identified the direction of asymmetry with 89% probability at 1 mm (.80 threshold), 93% probability at 2 mm (.90 threshold), and 95% probability at 3 mm (.95 threshold). For the covered block transverse process model, students correctly identified the direction of asymmetry with 80% probability at 1 mm (.80 threshold), 92% probability at 2 mm (.90 threshold), and 98% probability at 3 mm (.95 threshold). In the uncovered lumbar spine model (assessment 2), students correctly identified the direction of asymmetry with 93% probability at 2 mm (.80 and .90 threshold) and 95% probability at 3 mm (.95 threshold). In the covered lumbar spine model (assessments 2 and 3), students correctly identified the direction of asymmetry with 87% probability at 4 mm (.80 threshold); the .90 and .95 thresholds were not defined with the range of asymmetries tested. Conclusion: Most first-year osteopathic medical students were able to discern the direction of rotational asymmetry on static models of transverse processes. Future studies should evaluate whether accuracy when palpating lumbar spine models translates to accuracy when palpating humans.

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