“Skilled Mentors” and Reliability

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To the Editor: I am writing in response to the article by Riddle et al titled “Evaluation of the Presence of Sacroiliac Joint Region Dysfunction Using a Combination of Tests: A Multicenter Intertester Reliability Study” in the August 2002 issue of the Journal. The research design and statistical analysis used in this multi-center reliability study on examination of the sacroiliac region was impressive. The authors attempted to replicate an earlier study by Cibulka and colleagues,1 but they greatly increased the number of clinical sites and therapists involved, in an attempt to make the results more generalizable to therapists who might use the examination scheme advocated by Cibulka and colleagues. However, the results of the study by Riddle et al demonstrated poor reliability, whereas Cibulka et al had reported an excellent level of reliability. In comparing the 2 studies, it seems that one likely explanation for the disparity in results is the training process used in the studies. Cibulka et al1 developed the examination scheme and likely mentored their coworkers to perform the procedures exactly as they advocated in an attempt to maximize the consistency and reliability. In contrast, Riddle et al sent a written description of the examination procedures with illustrations to the participating physical therapists and asked them to practice the techniques on each other until they felt ready to participate in the study. Manual examination procedures are motor skills that must be practiced under the guidance of a mentor in order to be learned properly. The motor learning literature, I believe, suggests that practice of a motor skill is necessary for the skill to be learned. Petty2 contended that physical therapists in an advanced manual therapy residency program provided inaccurate and unreliable feedback to classmates when practicing manual therapy techniques. Watson and Radman3 showed …