Examen manual de la columna vertebral…(I)

«Examen manual de la columna vertebral: Una revisión crítica sistemática de la literatura de la reproductibilidad.»

Mette Jensen Stochkendahl DCa, , , Henrik Wulff Christensen DC, MD, PhDb, Jan Hartvigsen DC, PhDc, Werner Vach PhDd, Mitchell Haas DC, MAe, Lise Hestbaek DC, PhDf, Alan Adams DC, MS, MSEdg and Gert Bronfort DC, PhDh

aResearch Fellow, Nordic Institute of Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, Odense, Denmark bSenior Researcher, Nordic Institute of Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, Odense, Denmark cSenior Researcher, Nordic Institute of Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, Odense, Denmark; and Associate Professor, Institute of Sports Science and Clinical Biomechanics, Part of Clinical Locomotion Science, University of Southern Denmark, Denmark dProfessor, The Department of Statistics, University of Southern Denmark, Denmark eProfessor, Center for Outcomes Studies, Western States Chiropractic College, Portland, Ore fSenior Researcher, The Back Research Center, Backcenter Funen; and Part of Clinical Locomotion Science, University of Southern Denmark, Denmark gProfessor, Texas Chiropractic College, Pasadena, Tex hProfessor, Department of Research, Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, Bloomington, Minn

Abstract

Objective Poor reproducibility of spinal palpation has been reported in previously published literature, and authors of recent reviews have posted criticism on study quality. This article critically analyzes the literature pertaining to the inter- and intraobserver reproducibility of spinal palpation to investigate the consistency of study results and assess the level of evidence for reproducibility.

Methods Systematic review and meta-analysis were performed on relevant literature published from 1965 to 2005, identified using the electronic databases MEDLINE, MANTIS, and CINAHL and checking of reference lists. Descriptive data from included articles were extracted independently by 2 reviewers. A 6-point scale was constructed to assess the methodological quality of original studies. A meta-analysis was conducted among the high-quality studies to investigate the consistency of data, separately on motion palpation, static palpation, osseous pain, soft tissue pain, soft tissue changes, and global assessment. A standardized method was used to determine the level of evidence.

Results The quality score of 48 included studies ranged from 0% to 100%. There was strong evidence that the interobserver reproducibility of osseous and soft tissue pain is clinically acceptable (κ ≥ 0.4) and that intraobserver reproducibility of soft tissue pain and global assessment are clinically acceptable. Other spinal procedures are either not reproducible or the evidence is conflicting or preliminary.

Journal of Manipulative and Physiological Therapeutics Volume 29, Issue 6 , July-August 2006, Page 475.

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