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The validity of lumbo-pelvic landmark palpation by manual practitioners: a systematic review

Journal: International Journal of Osteopathic Medicine Date: 2020/10, . doi: Subito , type of study: systematic review

Full text    (http://www.sciencedirect.com/science/article/pii/S174606892030208X)

Keywords:

accuracy [4]
lumbar spine [43]
lumbo-pelvic [2]
manual practitioner [2]
palpation [170]
landmarks [7]
pelvis [34]
reference standard [2]
validity [23]
systematic review [297]
UK [80]

Abstract:

Background Lumbo-pelvic landmark palpation is widely used by manual practitioners as part of a clinical assessment. However, research has not clearly described or established the validity of landmark palpation as a diagnostic tool; we aimed to analyse and synthesise data on the validity of lumbo-pelvic landmark palpation compared to an imaging modality reference standard. Methods and Results Nine studies met the inclusion criteria (43 practitioners assessing 364 subjects). Mean palpatory accuracy ranged from 42-71%; four studies reported kappa values, ranging from 0.20 (no agreement) to 0.81 (strong); two studies could not be directly compared. The use of multiple palpation techniques improved palpation accuracy, however, no specific technique or technique combination was more accurate than another. Methodological quality was assessed using the QUADAS-2 check-list tool; eight studies were rated as having a risk of bias and/or concerns regarding applicability. Conclusion The use of lumbo-pelvic landmark palpation does not reach clinically acceptable levels of validity; however, heterogeneity in the included studies’ methods and data reporting limited between trial comparisons. These results accord with other reviews and suggest the necessity of a shift away from over-reliance on landmark palpation to align manual therapy with practise guidelines.


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