Simultaneous Palpation of the Craniosacral Rate at the Head and Feet: Intrarater and Interrater Reliability and Rate Comparisons

Abstract

Background and Purpose. The main purpose of this study was to determine the interrater and intrarater reliability of measurements obtained during palpation of the craniosacral rate at the head and feet. Palpated craniosacral rates of head and feet measured simultaneously were also compared. Subjects. Twenty-eight adult subjects and 2 craniosacral examiners participated in the study. Methods. A withinsubjects repeated-measures design was used. A standard cubicle privacy curtain, hung over the subject's waist, was used to prevent the examiners from seeing each other. Results. Interrater intraclass correlation coefficients (ICCs) were .08 at the head and .19 at the feet. Intrarater ICCs ranged from .18 to .30. Craniosacral rates simultaneously palpated at the head and feet were different. Conclusion and Discussion. The results did not support the theories that underlie craniosacral therapy or claims that craniosacral motion can be palpated reliably. [Rogers JS, Witt PL, Gross MT, et al. Simultaneous palpation of the craniosacral rate at the head and feet: intrarater and interrater reliability and rate comparisons.

Reliability of Diagnosis and Clinical Efficacy of Cranial Osteopathy: A Systematic Review

“…Note, that this last study reported unreliable results in terms of our criteria. Eight studies addressed the issue of inter-rater reliability [24–31] and 6 addressed the issue of intra-rater reliability [26–28,30–32]. Whether for inter- or intra-rater reliability studies, results were either unusable or did not show reliability for any of the investigated parameters.…”

“…On this last point, Halma et al [32] proposed a quite outstanding plan to isolate the examiner from tactile, visual, auditory and olfactory cues. Note also that for studies involving simultaneous evaluation of a subject by two separate examiners, the method sections detailed in studies by Rogers et al [28], Moran & Gibson [30] and Sommerfeld et al [31], should serve as models for this methodological approach.…”

Craniosacral Therapy: The Effects of Cranial Manipulation on Intracranial Pressure and Cranial Bone Movement

“…Multiple studies have shown poor reliability in palpating this rhythm. 6,17,32,42,51 The goals of craniosacral treatment according to Greenman 15 are to improve articular and membranous restrictions, reduce neural entrapment at the base of the skull, enhance the rate and amplitude of the cranial rhythmic pulse, and improve circulation by reducing venous congestion. As indicated in the literature review of this paper, there is support for small amounts of movement that occur between cranial bones based primarily on the role that sutures have in cranial compliance related to increases in ICP.…”

“…Intraclass correlation coefficients range from -0.09 to 0.59, with the majority of studies reporting a nonsignificant (PϾ.05) correlation of less than 0.22. 6,17,32,42,46,51 According to Green et al, 13 the reliability studies that were published after the initial Upledger study 46 in 1997 (ICC = .59) had better methodological designs and consistently found assessment of the craniosacral rhythm to be unreliable. Hartman and Norton 4 similarly state that the data collected to date demonstrate that the cranial rhythm is not a ''reliably palpable biological phenomenon'' and that this invalidates the key tenet of the primary respiratory mechanism as described by Sutherland 44 and endorsed by advocates of CST today.…”

Osteopathy in the cranial field – moving towards evidence for causality and effectiveness

“…For example, the 'core-link' hypothesis as taught in many undergraduate courses, and outlined in basic reference texts, 2,3 lacks concept validity as demonstrated by studies employing simultaneous palpation at the head and sacrum. 4,5 Studies investigating frequency alone do not directly address questions about the reliable detection of dysfunction on the basis that assessment of cranial rhythm frequency is only one of several characteristics used to identify dysfunction in an OCF model. Future studies of reliability in the cranial field should be broadened beyond frequency, and include other qualitative characteristics that are regarded by proponents as being of greater clinical relevance.…”