Response to Letter to the Editor by Perle

Abstract

We appreciate Dr. Perle’s interest in our recent publication, attempting to establish the validity of manual muscle testing in instances of cervical pain. While pointing out several cautionary notes common to clinical research, we have reason to believe that in this instance they are all misplaced in the four arguments that he has put forth: 1.Blinding: While blinding is a standard criterion of quality in traditional allopathic randomized controlled trials, its inclusion in trials involving physical medicine interventions is known to be highly problematical and in this instance could conceivably be considered to be sort of a blindman’s bluff ( Rosner, in press Rosner, A., (in press). Evidence-based medicine: Revisiting the pyramid of priorities. J. Bodywork Movement Ther. Google Scholar ). Furthermore, blinding has actually been known to have a detrimental effect on recruitment for clinical trials ( Hemminiki et al., 2004 Hemminiki E. Hovi S.L. Veerus P. Sevon T. Tuimala R. Rahu M. Hakama M. Blinding decreased recruitment in a prevention trial of postmenopausal hormone therapy. J. Clin. Epidemiol. 2004; 57: 1237-1243 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar ) taking into consideration more recent data which suggest that patient choice and awareness are desirable inclusions rather than the liability that Dr. Perle suggests ( Rosner, in press Rosner, A., (in press). Evidence-based medicine: Revisiting the pyramid of priorities. J. Bodywork Movement Ther. Google Scholar ). Finally, blinding has no place in standard clinical practice where manual muscle testing occurs and may actually introduce an unwanted element of stress. If research is to be effectively translated into practice, our attention needs to be focused more upon translational research ( Editorial, 2009 Editorial J. Bodywork Move. T. Ther. 2009; 13: 295-296 Abstract Full Text Full Text PDF Scopus (3) Google Scholar ) rather than the more artificial conditions imposed by blinding. 2.Different examiners: While patients with or without mechanical neck pain were tested by separate examiners, robust data exists to suggest that a substantial degree of inter-observer reliability exists in manual muscle testing ( Cuthbert and Goodheart, 2007 Cuthbert S.C. Goodheart G.J. On the reliability and validity of manual muscle testing: a literature review. Chiropractic & Osteopathy. 2007; 15: 4 Crossref PubMed Scopus (236) Google Scholar , Caruso and Leisman, 2000 Caruso W. Leisman G. A force/displacement analysis of muscle testing. Percep. Mot. Skills. 2000; 91: 683-692 Crossref PubMed Scopus (27) Google Scholar ). 3.Sensitivity and specificity: The standard calculation for sensitivity is TP/TP + FN, while for specificity it is TN/FP + TN where TP = true positive, TN = true negative, FP = false positive, and TN = true negative—precisely the numbers that were included in our paper. The reference values used in our calculations were the actual occurrences of neck pain as reported by the patient. 4.Ethical principals: Patient rights and safety in clinical research are well protected by the principles of the Nuremberg and Helsinki conventions. Indeed, patients were given full informed consent of the experimental details in this study and signed off to that effect. However, in situations such as this in which no experimental interventions of any kind were imposed, ethical committees and internal review boards are essentially irrelevant. This is simply because data from everyday patient appointments with their treating doctor were gathered retrospectively with no risk to, or imposition upon, the patient. In JBMT, as in most of the journals publishing research involving manual medicine, case and case-series reports are frequently published. Dr. Perle’s insistence on an “institutional review board’s” approval of all research printed in JBMT and elsewhere would have censored most of the research conducted in manual medicine for the past century. Correspondence re “Association of manual muscle tests and mechanical neck pain: Results from a prospective pilot study”Journal of Bodywork and Movement TherapiesVol. 15Issue 4PreviewI appreciate the fact that Cuthbert et al. (2011) have made a preliminary attempt to determine the validity of the Applied Kinesiology (AK) method of using muscle testing to determine the presence of a cervical pain disorder. Further, I am aware that this was a pilot study. However, I think the authors have erroneously concluded that their study provides evidence of the sensitivity and specificity of Applied Kinesiology manual muscle testing for determining who has cervical pain and can at best say that they have found that such research is feasible. Full-Text PDF