The validity of lumbo-pelvic landmark palpation by manual practitioners: a review and evaluation of the literature.

Item

Title
The validity of lumbo-pelvic landmark palpation by manual practitioners: a review and evaluation of the literature.
Author(s)
Alexander, N
Abstract
Background Palpation is an integral element of the examination routine used by manual practitioners, informing clinical diagnosis and treatment. Validity is required for an examination tool to be accurate and clinically useful; however, research has not definitively established the validity of palpation. Objective This study was conducted to synthesize and critically appraise the research regarding the validity of lumbo-pelvic landmark palpation by manual practitioners, as compared with a reference standard. Furthermore, to consider manual palpation's clinical applicability, and resultant implications for clinical practice, research and the development of manual therapy practice standards. Design A structured literature review design was used for this study. Methods 8 databases were reviewed and reference lists checked for relevant research published between 1990 and 2015. Search returns were filtered by two reviewers according to inclusion / exclusion criteria developed to reflect the research question. Six papers met the criteria for inclusion in this study. Data was extracted regarding study design, study aim (landmark assessed), subject and practitioner details, details of the index test and reference standard procedure, results and methodological limitations. Two blinded reviewers conducted a quality assessment of included studies using the validated QUADAS-2 tool. Results Five of the six studies assessed using the QUADAS-2 quality assessment tool were either at risk of bias or had concerns regarding applicability; only one study had no methodological issues identified. All of the studies included in this review assessed the validity of palpation of lumbar spinous processes; one study also considered pelvic landmarks. Study practitioners included physiotherapists, manual physiotherapists, manual therapists and osteopathic physicians. The reference standards used to determine palpation validity included X-.rays, ultrasound and positional MRI (pMRl). Overall, unacceptable levels of palpation accuracy were reported (42% - 71%). Using multiple techniques to identify landmarks was generally reported to increase palpation accuracy; however, no specific technique or technique combination was indicated Only one study reported subject characteristics having a statistically significant influence on accuracy. One study investigated the influence of practitioner characteristics on accuracy, and reported examiner experience having a statistically significant influence on accuracy. Discussion Collation and interpretation of study findings were limited by heterogeneity in study methods and measures, test procedures and statistical reporting. Study quality issues identified with regards to risk of bias or limitations in applicability further complicate resulting conclusions. The validity of palpation is potentially clinically unacceptable, and the factors influencing it require clarification. Conclusions This review highlighted heterogeneity and quality limitations in the literature, confounding interpretation of the results. Therefore, the validity of landmark palpation remains in question. Results of this review indicate that optimizing clinical efficacy of landmark palpation requires the use of multiple palpation techniques. Well-designed and rigorous research is required to establish the validity of palpation as a clinical diagnostic tool and describe the palpation methods that optimize accuracy. Establishing palpation's validity is essential to the quality of clinical practice, the education of manual practitioners, and the development of healthcare policies.
presented at
European School of Osteopathy
Date Accepted
2016
Date Submitted
2.12.2016 17:29:03
Type
osteo_thesis
Language
English
Submitted by:
62
Pub-Identifier
15931
Inst-Identifier
1229
Keywords
Accuracy, Lumbo pelvic, Palpation, Validity.
Recommended
0
Item sets
Thesis

Alexander, N, “The validity of lumbo-pelvic landmark palpation by manual practitioners: a review and evaluation of the literature.”, Osteopathic Research Web, accessed May 5, 2025, https://www.osteopathicresearch.org/s/orw/item/550