Does perceived practitioner positional comfort increase inter- and intra-examiner reliability in final-year under-graduate osteopathic students in the static palpation of posterior superior mac spines? An observational undergraduate study.

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Title: Does perceived practitioner positional comfort increase inter- and intra-examiner reliability in final-year under-graduate osteopathic students in the static palpation of posterior superior mac spines? An observational undergraduate study.
Author(s): Hansen, F
Abstract: Background: Palpatory inter- and intra-rater agreement has continuously been shown to be unsatisfactory. It has been suggested in commonly used osteopathic literature and at OEIs that physical and mental relaxation and comfort are vital to accurate palpation. Objectives: To determine a) intra-rater agreement for consistency of digital marker placement on photographs; b) inter-examiner reliability of palpating the PSIS' of prone and anonymised (by covering) subjects; c) intra-rater reliability of palpating the PSIS' of prone and anonymised (covered) subjects; d) associations between positional comfort and inter- and intra-rater agreement. To simplify the method of measuring and standardising palpation between raters. Design: A longitudinal observational inter- and intra-rater reliability study using repeated measures. Participants; subjects - convenience sample of asymptomatic students; raters -convenience sample of final-year osteopathic students. Methods: Photographs of three raters' thumbs locating three subjects' posterior superior iliac spines (PSIS) were taken during five repeated measures (blinded to each other's identity). Raters gave a comfort rating for each palpation via a numeric rating scale (NRS). Research ethics approval was attained. Intra-class correlation coefficient (ICC) was calculated for: a) consistency of digital marker placement on photographs; b) inter-examiner agreement by subject; c) intra-examiner agreement by rater. Benchmarking scale used Duffy and Jacobson 2005). To determine associations between perceived comfort and reliability, comfort values were plotted against resultant ICC values. Results: Inter-rater agreement for marking consistency was 'very high' (lCCmean=O.99). Intra rater agreement for PSIS palpation for all raters was _very high' (ICCmean=O.96). Inter-rater agreement for PSIS palpation for all subjects was 'high' (lCCmean=O.89). No correlation was found between comfort levels and ICC values (95% confidence interval (CI); p-value =O.2885). Discussion: These results are contrary to previous findings. Possible methodological flaws have to be considered. The very reductionist setting eliminated patient interaction and interpretation of palpatory finding which is not representative of clinical practice. The small sample size and number of readings made analysis unreliable, and the subjectivity of palpation and absence of a gold standard limits external validity of this study. Conclusion: Both intra- and inter-rater agreement was 'high' and 'very high', but no correlation was found between comfort and palpation. These findings suggest that some osteopathic students may be able to reliably find a particular landmark in a reductionist setting. However, these results are not transferable into practice. Larger sample sizes and lab-based approached are required.
presented at: European School of Osteopathy
Date Accepted: 2015
Date Submitted: 2.12.2016 16:54:59
Type: osteo_thesis
Language: English
Submitted by:: 62
Pub-Identifier: 15894
Inst-Identifier: 1229
Keywords: Comfort; palpation; posterior superior iliac spines; reliability and validity
Recommended: 0

Item sets: Thesis

Hansen, F, “Does perceived practitioner positional comfort increase inter- and intra-examiner reliability in final-year under-graduate osteopathic students in the static palpation of posterior superior mac spines? An observational undergraduate study.”, Osteopathic Research Web, accessed April 23, 2025, https://library.wso.at/s/orw/item/587