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Does Using a Shim Improve the Diagnostic Reliability of the Standing Flexion Test? A Pilot Study

Journal: The AAO Journal Date: 2016/09, 26(3):Pages: 21-25, type of study: controlled clinical trial

Full text    (https://www.academyofosteopathy.org)

Keywords:

standing flexion test [4]
diagnosis [263]
reliability [114]
interexaminer reliabilty [1]
controlled clinical trial [283]

Abstract:

Context: The standing flexion test (StFT) is a key component in the osteopathic screening exam. Leveling the iliac crests prior to performing the test is thought to improve the reliability of the StFT. Objective: This pilot study was designed to investigate whether using a shim to level the iliac crests changes the diagnostic reliability of the StFT and to appraise the interexaminer reliability of the StFT between 2 qualified examiners. Methods: Examiners consisted of 2 osteopathic manipulative medicine predoctoral teaching fellows and 2 first-year osteopathic medical students, all of whom underwent consensus training. Each participant was evaluated by 2 examiners using the StFT, and results were recorded. If iliac crest levels were asymmetrical, a shim was used and a second standing flexion test was performed. Results: Of the 64 participants in the study, the use of a shim changed the results of the standing flexion test 65.2%, 64.3%, 41.2%, and 64.3% of the time for participants assessed by examiners 1, 2, 3, and 4, respectively. Additional results yielded statistically insignificant interexaminer reliability with moderate reliability (k=0.43) between examiners with higher levels of palpatory experience. Conclusion: These results suggest that the use of shims to level uneven iliac crests influences the results of the StFT. There is poor interexaminer reliability performing the StFT despite having examiners complete a consensus training session where they reviewed the standardized protocol. However, level of palpatory experience may influence interexaminer reliability.


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