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Chiropractic Research Review

Identifying Dysfunctional Joint Segments in the Thoracolumbar Spine

Spinal manipulation is one of the most common treatments used in the management of low back pain. Key to the classification of musculoskeletal disease is the proper diagnosis of a biomechanical joint dysfunction.

However, while diagnosis of joint dysfunction is considered a vital precursor to appropriate spinal manipulation, few studies have been performed that measure a practitioner's ability to identify joints that exhibit signs of biomechanical dysfunction.

To determine the reliability of practitioners in identifying manipulable lesions in the thoracic and lumbar spine, 12 asymptomatic patients were examined for signs of joint segment dysfunction. Following both dynamic and static examination, the selected segment was marked with an ultraviolet invisible sign. A second examiner visualized these marks and recorded them on acetate slides. The process was then repeated an hour later, with a one-way analysis of variance performed to test for differences between measurements for both spinal areas. Intrarater reliability was calculated using intraclass correlation coefficients (ICC).

Results: Reliability of identification of a dysfunctional joint in the thoracic spine was considered "moderate to poor," with an ICC of 0.70. Reliability of identification of a dysfunctional joint in the lumbar spine was termed "excellent," with an ICC of 0.96. Limits of agreement plots revealed no systematic difference between the position of the two marks.

"These results show that in an asymptomatic sample using a standardized assessment protocol, the within-day intrarater reliability for detecting the joint most suitable to receive a spinal manipulation was excellent for clinical measurement in the lumbar spine but moderate to poor in the thoracic spine," the authors concluded. They also noted that the study's findings "add to the evidence that manual palpation of the lumbar spine is a reliable method for establishing a joint suitable for spinal manipulation," although the results should be interpreted with some caution, given that the study population was small and the subjects asymptomatic.

Potter L, McCarthy C, Oldham J. Intraexaminer reliability of identifying a dysfunctional segment in the thoracic and lumbar spine. Journal of Manipulative and Physiological Therapeutics 2006;29:203-207.

Chiropractic Research Review

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