The effects of experience on the inter-reliability of osteopaths to detect changes in posterior superior iliac spine levels using a hidden heel wedge

Abstract

The use of palpation to diagnose musculoskeletal dysfunction is commonly taught within osteopathy and other manual therapies. However the clinical tests used to detect sacroiliac joint dysfunction have not shown good reliability. To investigate the inter-examiner reliability of osteopaths to detect asymmetries of the posterior superior iliac spine (PSIS), and to determine if inter-examiner reliability was affected by the level of practitioner experience. Fifteen final year osteopathic students (n = 15), fifteen third year osteopathic students (n = 15) and ten experienced osteopaths (n = 10) manually palpated the levels of the PSIS in one model nine consecutive times. A hidden 5 mm heel wedge was used to alter the height of the PSIS which was hidden from the examiners. Scores were analysed using Fleiss Kappa (Fκ) statistics and one way analysis of variance on ranks (ANOVA). All three groups produced Fκ results below 0.4 (0.025-0.065), indicating poor inter-examiner reliability. Fκ values less than 0.4 are considered to be clinically unreliable. ANOVA testing did not show any significant difference between groups. This study showed 'poor' inter-examiner reliability in detecting asymmetries of the PSIS. This is in accordance with other studies in the field. It is suggested that the inclusion of this osteopathic model within osteopathic education should be reviewed.