Reliability of spinal palpation for diagnosis of back and neck pain: a systematic review of the literature.

Seffinger MA et al Spine Oct 2004

OBJECTIVES:
To determine the quality of the research and assess the interexaminer and intraexaminer reliability of spinal palpatory diagnostic procedures.

SUMMARY OF BACKGROUND DATA:
Conflicting data have been reported over the past 35 years regarding the reliability of spinal palpatory tests.

METHODS:
The authors used 13 electronic databases and manually searched the literature from January 1, 1966 to October 1, 2001. Forty-nine (6%) of 797 primary research articles met the inclusion criteria. Two blinded, independent reviewers scored each article. Consensus or a content expert reconciled discrepancies.

RESULTS:
A higher percentage of the pain provocation studies (64%) demonstrated acceptable reliability, followed by motion studies (58%), landmark (33%), and soft tissue studies (0%). Regional range of motion is more reliable than segmental range of motion, and intraexaminer reliability is better than interexaminer reliability. Overall, examiners’ discipline, experience level, consensus on procedure used, training just before the study, or use of symptomatic subjects do not improve reliability.

CONCLUSION:
The quality of the research on intra reliability and intra reliability of spinal palpatory diagnostic procedures needs to be improved. Pain provocation tests are most reliable. Soft tissue paraspinal palpatory diagnostic tests are not reliable.