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Sunday, 30 October 2011

Palpation: Is It Necessary?

 Palpation is the act of examining by touch to help diagnose illness or disease in people.  Physical therapists often use palpation to help decide on the best treatment strategy for their patients.
Palpation can be used to feel muscles, tendons, bones or ligaments to test for trigger points, hypermobility, or hypomobility.  Sometimes palpating tissue can detect warmth, indicating possible inflammation or infection.    In the evaluation and treatment of low back pain, palpation is often used to assess spinal segmental motion and pain over various structures in the back.
But is the information gathered by palpating a body part reliable?
Most published studies indicate that the answer is "no."
A study in the Journal of Manipulative and Physiological Therapeutics investigated the inter-rater reliability of spinal palpation for lumbar segmental mobility and pain provocation.  Two clinicians palpated spinal segments and sacroiliac joints of 39 patients and independently assessed pain provocation, segmental mobility, and instability.
The findings: there was poor inter-rater agreement for spinal segmental motion testing.  In fact, the statistical results indicated negative kappa coefficients.  Here's the skinny on kappa: When two people are rating something, a kappa value equal to 1 means they are in agreement and very little chance is involved.  A kappa value equal to 0 means that there is no agreement between the raters other than what is expected by chance.
A negative kappa value pretty much means that you could flip a coin to assess spinal segmental motion and do better than palpation as an assessment.
For those of you keeping score:  in the study, pain provocation kappa values ranged from .21 to .73 and instability testing was .54.  Not great reliability, but not too bad either.
What does this all mean?  It means that if you have low back pain and your physical therapist palpates your back and finds hypermobility, another therapist may find hypomobility.  Palpation is just not a great tool to assess the condition of your back and make clinical decisions.  Any information gathered from palpation should be considered, but considered lightly.  Other tests and measures, like range of motion, repeated motion testing, and strength are more reliable.

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