The effects of experience on the inter-reliability of osteopaths to detect changes in posterior superior iliac spine levels using a hidden heel wedge.

BACKGROUND: The use of palpation to diagnose musculoskeletal dysfunction is commonly taught within osteopathy and other manual therapies. However the clinical tests used to detect sacroiliac joint dysfunction have not shown good reliability. OBJECTIVES: To investigate the inter-examiner reliability of osteopaths to detect asymmetries of the posterior superior iliac spine (PSIS), and to determine if inter-examiner reliability was affected by the level of practitioner experience. METHODS: Fifteen final year osteopathic students (n = 15), fifteen third year osteopathic students (n = 15) and ten experienced osteopaths (n = 10) manually palpated the levels of the PSIS in one model nine consecutive times. A hidden 5 mm heel wedge was used to alter the height of the PSIS which was hidden from the examiners. Scores were analysed using Fleiss Kappa (Fκ) statistics and one way analysis of variance on ranks (ANOVA). RESULTS: All three groups produced Fκ results below 0.4 (0.025-0.065), indicating poor inter-examiner reliability. Fκ values less than 0.4 are considered to be clinically unreliable. ANOVA testing did not show any significant difference between groups. CONCLUSION: This study showed 'poor' inter-examiner reliability in detecting asymmetries of the PSIS. This is in accordance with other studies in the field. It is suggested that the inclusion of this osteopathic model within osteopathic education should be reviewed.

The suitability of sham treatments for use as placebo controls in trials of spinal manipulative therapy: a pilot study.

Despite the augmented use and dependence on manual therapy (MT), there are still calls from both within and outside the MT professions to provide robust evidence that spinal manipulative therapy (SMT) induces therapeutic effects beyond placebo. To facilitate this, placebo or 'sham' treatments, the development of which is notoriously difficult, must be used in rigorously controlled trials. The aim of this study was to investigate the suitability of different shams as controls in SMT trials. A repeated measures, single-blind, randomised trial was conducted on 10 asymptomatic subjects. Pain pressure thresholds (PPTs) were measured at 2 sites, local and systemic, before and after the application of either high-velocity low-amplitude thrust (HVLAT), sham functional technique (SFT), sham ultrasound (SUS) or no intervention control (NIC) to the cervico-thoracic (CT) junctional area. Treatment credibility was then assessed using a 4-point Likert Scale in response to 4 statements. Results demonstrated no significant change in PPT following any of the interventions, irrespective of site tested. The effect sizes for all interventions were considered small (d = <0.2). There were significant differences in Likert Scale responses for each statement (P < 0.001), with SUS eliciting significantly different responses as compared to SFT and NIC but not, predominantly, with HVLAT. SUS is implicated as being the most effective sham, having high fidelity to subjects' perceptions of a 'real' treatment, whilst being therapeutically inert i.e. results in no significant change in clinical status.