Objective: To validate and compare leg-length assessment, visual assessment, qi energy palpation and palpation of tender points to the motion palpation technique of the thoracic spine to determine the level of chiropractic subluxation. This information is important to give guidance to chiropractors and other manual therapy providers on which diagnostic palpation techniques should be used in practice. Determining which assessment procedures have the best intraexaminer and interexaminer reliability is important for improving clinical outcomes and ensuring that evidence-based chiropractic diagnostic techniques become more widely practiced.
Methods: Anonymous and voluntary pilot study with student participants recruited from our university. A total of 50 participants between the ages of 20 and 40 years old took part in this study. There were 29 men and 21 women. The following 5 palpation methods were used on the participants’ thoracic spines assessing for the level of subluxation from the T1 through T12 vertebral levels: motion palpation, Qi energy palpation, visual inspection, leg-length evaluation using the Activator Methods Chiropractic Technique (AMCT), and tenderness palpation. All participants were assessed in the prone position. All examiners were blinded to the findings from the other examiners and to the identity of the participants. Cohen’s Kappa (κ) test was used to determine the level of agreement between examiners for our study. The Landis scale for interpreting kappa was used to display the findings
Results: A total of 50 students participated in the study. The total number of subluxations found at each level of the thoracic spine by the 5 examiners was determined. There was little agreement between the examiners. For the entire thoracic spine, the level of agreement between the motion palpation technique and the other techniques ranged from none to slight. At the individual vertebrae level, agreement was similar with the exceptions of visual inspection at T1 (κ =0.357) and leg-length assessment at T12 (κ =0.345).
Conclusion: Practitioners who use manipulation of the spine need a valid and reliable method to detect subluxations of the vertebra. This study did not find acceptable levels of agreement between 4 different methods of palpation compared with motion palpation for detecting subluxations in the thoracic spine. Further research should be conducted using symptomatic patients to determine if any of these palpation methods can be reliable and valid.
Author keywords: Chiropractic; Motion Palpation; Thoracic Spine
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