Reliability of Entry-Level Athletic Trainers' Palpation Skills of Bony Anatomical Landmarks in the Lumbopelvic Region

Abstract

Context Accuracy of locating various lumbopelvic landmarks for novice athletic trainers has not been examined. Objective To examine reliability of novice athletic trainers for identification of the L4 spinous process and right and left posterior superior iliac spine (PSIS). Design Cross-sectional reliability. Setting Laboratory. Patients or Other Participants Sixteen physically active volunteers participated (age = 22.56 ± 2.67 years, height = 172.0 ± 9.38 cm, mass = 67.39 ± 9.73 kg, body mass index = 22.8 ± 1.97). Four novice athletic trainers (certified < 2 years) served as the testers of interest. Intervention(s) Subjects were placed prone and 2 expert athletic trainers (certified > 12 years) agreed upon each bony landmark and transferred the palpation markings to contact paper. Each novice athletic trainer palpated the landmarks twice within the same test session and used the same method as the experts for transfer and recording. Novice athletic trainers rotated between subjects after 1 marking trial. Expert marks were transposed over the tester marks to assess distance and agreement. Main Outcome Measure(s) Independent variables were novice athletic trainer (AT1, AT2, AT3, AT4) and time (Trial 1, Trial 2); dependent variables included distance from the expert marking in millimeters for L4 and PSIS palpations, and agreement within or outside of a designated area for the L4 spinous process. Intraclass correlation coefficients (ICC [2,1]), standard error of measurement, and percent agreement were calculated. Results Intratester reliability for L4 ranged from 0.370 to 0.833, right PSIS (RPSIS) ranged from 0.371 to 0.771, and left PSIS (LPSIS) ranged from −0.173 to 0.760. Intertester ICC (2,1) for Trial 1 and Trial 2 were, respectively, 0.319 and 0.466 (L4), 0.213 and 0.002 (RPSIS), and 0.96 and 0.073 (LPSIS). Percent agreement between expert and testers ranged from 18.75%–81.3% for L4 spinous process. Conclusions Our results indicate novice athletic trainers are generally poor at reliably locating lumbopelvic anatomical landmarks, and this should be addressed within educational programming.