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Haas, Mitchell; Groupp, Elyse; Panzer, D; Partna, Lester; Lumsden, Steve; Aickin, Mikel

doi:10.1097/00007632-200306010-00002

Cited by 13 publications

(24 citation statements)

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“…If manual assessments of spinal stiffness are simply unreliable and invalid, their continued use during clinical examination is difficult to justify. This conclusion has been reached by several other authors after reviewing the reliability literature (Troyanovich et al 1998; Seffinger et al 2004) and is consistent with studies that find a lack of association between assessments of spinal motion and clinical outcomes (Chiradejnant et al 2003a; Haas et al 2003; Kanlayanaphotporn et al 2009). …”

Section: Discussionsupporting

confidence: 89%

“…Several studies reported that choosing a manual therapy technique based on assessments of spinal stiffness results in no better outcomes than random selection (Chiradejnant et al 2003a; Haas et al 2003; Kanlayanaphotporn et al 2009). Moreover, as a part of a population-based study, Leboeuf-Yde et al (Leboeuf-Yde et al 2002) found that manual assessments of spinal stiffness were not helpful in differentiating people with and without LBP.…”

Section: Introductionmentioning

confidence: 99%

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Criterion validity of manual assessment of spinal stiffness

et al. 2014

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Assessment of spinal stiffness is widely used by manual therapy practitioners as a part of clinical diagnosis and treatment selection. Although studies have commonly found poor reliability of such procedures, conflicting evidence suggests that assessment of spinal stiffness may help predict response to specific treatments. The current study evaluated the criterion validity of manual assessments of spinal stiffness by comparing them to indentation measurements in patients with low back pain (LBP). As part of a standard examination, an experienced clinician assessed passive accessory spinal stiffness of the L3 vertebrae using posterior to anterior (PA) force on the spinous process of L3 in 50 subjects (54% female, mean (SD) age = 33.0 (12.8) years, BMI = 27.0 (6.0) kg/m2) with LBP. A criterion measure of spinal stiffness was performed using mechanized indentation by a blinded second examiner. Results indicated that manual assessments were uncorrelated to criterion measures of stiffness (spearman rho = 0.06, p = 0.67). Similarly, sensitivity and specificity estimates of judgments of hypomobility were low (0.20–0.45) and likelihood ratios were generally not statistically significant. Sensitivity and specificity of judgments of hypermobility were not calculated due to limited prevalence. Additional analysis found that BMI explained 32% of the variance in the criterion measure of stiffness, yet failed to improve the relationship between assessments. Additional studies should investigate whether manual assessment of stiffness relates to other clinical and biomechanical constructs, such as symptom reproduction, angular rotation, quality of motion, or end feel.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Criterion validity of manual assessment of spinal stiffness

et al. 2014

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“…It may explain how target vs non-target site manual therapy interventions can show similar clinical efficacy. 13,60–62 In a recent study using the same model as the current study, the increase in L 6 muscle spindle response caused by an HVLA-SM is not different between 3 anatomical thrust contact sites (spinous process, lamina, mammillary body) on the target L 6 vertebra but is significantly less when the contact site is located 1 segment caudal at L 7 (Reed et al submitted). The current study confirms that a non-target HVLA-SM compared to a target HVLA-SM decreases spindle response but adds the caveat that a substantial percentage (60–80%) of afferent response can be elicited from an HVLA-SM delivered 2 segments away irrespective of the absence or presence of intervertebral fixation.…”

Section: Discussionsupporting

confidence: 49%

“…To date, at least 2 randomized clinical trials involving HVLA-SM support the concept that while precise segmental level accuracy may be ideal, it is not an absolute prerequisite for clinical efficacy. 13,62 …”

Section: Discussionmentioning

confidence: 99%

Paraspinal Muscle Spindle Response to Intervertebral Fixation and Segmental Thrust Level During Spinal Manipulation in an Animal Model

Reed

Pickar

2015

Spine

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Study Design In vivo cat model study. Objective To determine whether intervertebral facet joint fixation and segmental thrust level alter paraspinal muscle spindle activity during simulated spinal manipulation. Summary of Background Data Intervertebral motion is commonly assessed by manual therapy practitioners during clinical evaluation and treatment. Mechanoreceptor activity elicited during spinal manipulation has been theorized as a potential mechanism of its efficacy. The degree to which intervertebral fixation and segmental thrust level alter paraspinal muscle spindle activity during high velocity low amplitude spinal manipulation (HVLA-SM) is unclear. Methods Intervertebral fixation was created by inserting facet screws through the left L5–6, L6–7 and left L4–5, L5–6, L6–7, facet joints of a cat spine. Changes in the mean instantaneous frequency of L6 muscle spindle discharge were determined during five HVLA-SM thrust durations ((0-control, 75, 100, 150, 250ms) delivered at the L4 or L6 spinous process in each of 3 conditions within the same preparation: laminectomy-only (surgical control; n=23), L5–6 and L6–7 fixations (n=20), and L4–5, L5–6, and L6–7 fixations (n=7). Comparisons were made between thrust levels, thrust durations and spinal joint conditions using a linear mixed model. Results Insertion of facet screws compared to laminectomy-only significantly increased (P<.001) lumbar spinal stiffness during L6 HVLA-SM. Compared to laminectomy-only, both the 2 facet screw (100ms; P<.05) and 3 screw conditions [75 and 100ms (P<.001), 150 ms (P<.005), and 250 ms (P<.05)] significantly decreased L6 spindle response during the L6 HVLA-SM. HVLA-SM delivered 2 segments rostral to the level of muscle spindle input significantly decreases spindle response compared to HVLA-SM delivered at-level, however non-target HVLA-SM still elicits 60–80% of at-level muscle spindle response. Conclusions Intervertebral fixation decreases paraspinal muscle spindle response during L6 HVLA-SM in a cat model. While HVLA-SM target accuracy maximizes spindle response, non-target HVLA-SM still elicits substantial levels of muscle spindle activity.

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“…Moreover, even were they accurate, the information might prove to be of little clinical utility. An innovative efficacy study [29] using a randomized trial study design explored whether the data provided by MP was associated with a clinically relevant pain reduction in one session of cervical manipulation compared with non-specific cervical manipulation. Although the study found endplay assessment did not contribute to same-day clinical improvement in the cervical spine, the investigators did not rule out possible contribution over a longer term.…”

Section: Discussionmentioning

confidence: 99%

The reliability of spinal motion palpation determination of the location of the stiffest spinal site is influenced by confidence ratings: a secondary analysis of three studies

Cooperstein

Young

2016

Chiropr Man Therap

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BackgroundThis is a secondary analysis of three previous studies on the cervical, thoracic, and lumbar spines. It uses continuous analysis of the stiffest spinal site rather than more typical level-by-level analysis to assess interexaminer reliability, and the impacts of examiner confidence and spinal region. The primary goal was secondary analysis of the combined data; secondary goal was de novo analysis of combined data emphasizing absolute indices of examiner agreement; and tertiary goal was analysis of actual vs. simulated data to determine to what degree the information provided by motion palpation impacted interexaminer reliability.MethodsThis study emphasized Median Absolute Examiner Differences and Bland-Altman Limits of Agreement to calculate examiner differences, which are immune to subject homogeneity, and de-emphasized intraclass correlation, which is not. It calculated Median Absolute Deviation to determine data dispersion. The study analyzed the entire n = 113 combined dataset, as well as subgroups stratified by examiner confidence and spinal region. Simulations were run using a random number generator to provide chance data for examiners' findings of the stiffest spinal site, the analysis of which was compared with that of the actual data.ResultsMedian Absolute Examiner Differences for the combined dataset were 0.7 of one vertebral level, suggesting examiners usually agreed on the stiffest spinal site or the motion segment including it. When both examiners were confident in their findings (53.4%), the median examiner difference decreased to 0.6 levels, increasing to 1.0 levels when one lacked confidence and to 1.8 levels when both lacked confidence. Reliability was greater in the cervical and lumbar spines (each 0.6 vertebral levels examiner differences) than in the thoracic spine (1.1 levels examiner differences). The actual information provided by motion palpation compared to simulated data improved interexaminer reliability by a factor ranging from 1.8 times to 4.7 times, depending on the regional subset analyzed.ConclusionsExaminer decisions regarding the location of the stiffest spinal site were deemed adequately reliable, especially when the examiners were confident. Researchers and clinicians alike might best design their study protocols and practice methods using the stiffest segment protocol as an alternative to level-by-level spinal analysis.

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Cited by 13 publications

References 0 publications

Criterion validity of manual assessment of spinal stiffness

Criterion validity of manual assessment of spinal stiffness

Paraspinal Muscle Spindle Response to Intervertebral Fixation and Segmental Thrust Level During Spinal Manipulation in an Animal Model

The reliability of spinal motion palpation determination of the location of the stiffest spinal site is influenced by confidence ratings: a secondary analysis of three studies

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