Inter-examiner reliability of palpation for tissue texture abnormality in the thoracic paraspinal region

Abstract 

Background

Palpation of soft tissue changes is claimed to be important for osteopathic diagnosis and treatment. Few studies, however, have examined the inter-examiner reliability for the detection of altered segmental paraspinal tissue texture.

Objective

To determine the inter-examiner reliability of the identification of abnormal tissue texture in the thoracic paraspinal region using palpation.

Method

Ten final-year osteopathic students examined the thoracic paravertebral gutter regions of ten subjects presenting with a recent history of thoracic symptoms. Each examiner palpated each subject to determine which of four predetermined areas exhibited the most obvious alteration or abnormality in tissue texture. One week prior to the study, all examiners received consensus training to standardise the method of palpation.

Results

The inter-examiner agreement for the site with the most marked tissue texture change was fair (κ=0.26; P_o=0.46; P_e=0.28; 95% CI 0.19–0.33). When only the first five assessments from each examiner were analysed, the agreement improved slightly, but remained fair (κ=0.32; P_o=0.52; P_e=0.30; 95% CI 0.16–0.47).

Conclusions

Inter-examiner reliability of palpation for abnormal tissue texture in the deep thoracic paraspinal region was only fair. The influence of either examiner fatigue or tissue change due to repeated palpation appeared to be small. Although the practice of palpating for segmental tissue texture abnormalities without concurrent reports of tenderness from the patient is not typical of clinical practice, this study suggests that assessment of texture change is complex and not highly reproducible between examiners.

Keywords: Reliability, Palpation, Muscle, Osteopathic medicine, Manual therapy