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Inter-rater Reliability of Rib Strain-Counterstrain Tenderpoints

Journal: The Journal of the American Osteopathic Association Date: 2007/08, 107(8):Pages: 330-331. doi: Subito , type of study: Intra- inter rater reliability study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2007.107.8.327/html)

Keywords:

counterstrain [59]
inter-examiner reliability [19]
observational study [217]
palpation [214]
rib [66]
tender points [15]

Abstract:

Objective: The purpose of the study was to assess the reliability between two Osteopathic Manipulative Medicine student teaching fellows palpating a designated set of rib counterstrain tenderpoints. Methods: After IRB approval, eighty volunteer subjects were recruited from the staff and student body at Western University of Health Sciences. Of the 80, 33 (41%) were randomly selected for the reliability study using an uncharted wrist tenderpoint between the distal radial-ulnar bones. Subjects were included if they were 18 or over, had no current open wounds or fractures in the regions of palpation, and had no tenderness at the uncharted wrist tenderpoints. A total of 14 points were assessed for each subject. Rib tenderpoints, which are on the bony surface of the ribs, consisted of anterior ribs 2-6 and posterior rib 1 bilaterally. The omohyoid tenderpoints (located at the inferior attachment of that muscle on each scapula), were used as non-bony reference points. A 0-10 point verbal pain scale was used upon digital provocation. The pressure applied for palpating the tenderpoints was pre-determined between the examiners to blanch no greater than the first 1/3 of the fingernail bed. Examiner 1 entered the room with the subject supine on a treatment table, assessed all 14 tenderpoints and then left the room. Examiner 2 entered the room within 1 minute, blinded to the results of examiner 1, and instructed the subject to give responses on the 0-10 verbal pain scale independent to the responses given to examiner 1. Results: Pain scores within a 1-point difference or within a 2-point difference at each tenderpoint were considered as “agreement”. Rib scores within 1-point difference: 71% agreement; κ=0.61; within 2-point difference: 88% agreement; κ=0.84. For the omohyoid tenderpoint, within 1-point difference: 85% agreement; κ=0.76; within 2-point difference: 92% agreement; κ=0.88. There were no significant differences between kappa scores for the rib and muscle tenderpoints (p>.05). Conclusion: There is good inter-examiner reliability between OMM student teaching fellows at assessing standard rib counterstrain tenderpoints using agreed upon amount of digital pressure. Inter-examiner reliability is comparable between the rib and reference muscle tenderpoints.


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