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Interexaminer Reliability of Osteopathic Palpatory Findings

Journal: The Journal of the American Osteopathic Association Date: 2005/07, 105(7):Pages: 320. doi: Subito , type of study: observational study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2005.105.7.317/html)

Keywords:

inter-examiner reliability [16]
observational study [152]
palpation [190]

Abstract:

Hypothesis: The study of interexaminer reliability of osteopathic palpatory findings is a research priority. Methods: Subjects in this study were recruited for subsequent participation in a case-control study of osteopathic palpatory findings in type 2 diabetes mellitus at the University of North Texas Health Science Center during 2002-2003. Standardized osteopathic palpatory examinations were performed by two independent predoctoral osteopathic manipulative medicine fellows who were blinded to each subject’s case-control status. Six fellows (three non-overlapping pairs) performed these examinations at various times during the study. The examinations were used to determine the presence or absence of skin changes, trophic changes, tissue changes, tenderness, and immobility at spinal segments T5-T7, T8-T10, and T11-L2 on either the left or right side. Interexaminer agreement between the fellows who examined a given subject was summarized both as a crude proportion and the chance-adjusted kappa value. Results: A total of 91 subjects were included in the analysis. Overall, the proportional agreement was 0.68 (kappa, 0.35). Similar levels of proportional agreement (and kappa) were observed according to spinal segment and laterality: 0.67 (0.34) for T5-T7, 0.67 (0.35) for T8-T10, 0.69 (0.36) for T11-L2, 0.67 (0.34) for left-sided findings, and 0.68 (0.36) for right-sided findings. Overall proportional agreement (and kappa) for each of the five palpatory elements were: 0.69 (0.16) for skin changes, 0.66 (0.28) for trophic changes, 0.58 (0.05) for tissue changes, 0.84 (0.54) for tenderness, and 0.62 (0.09) for immobility. Conclusions: The overall level of chance-adjusted agreement of osteopathic palpatory findings in this study is comparable to that reported for other commonly used diagnostic tests, such as electrocardiograms to identify ST-T responses and peripheral blood films to diagnose iron-deficiency anemia. Although interexaminer agreement between fellows does not vary substantially according to spinal segment and laterality, it does vary according to the element of osteopathic palpation being performed.


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