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J Manipulative Physiol Ther. 2006 Mar-Apr;29(3):203-7.

Intraexaminer reliability of identifying a dysfunctional segment in the thoracic and lumbar spine.

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Centre for Rehabilitation Science, University of Manchester, Central Manchester and Manchester Children's University Hospital's NHS Trust, Manchester, UK.



To examine the intrarater reliability of identifying a manipulable lesion in the lumbar and thoracic spine.


An experienced osteopath used dynamic and static examination to assess 12 asymptomatic subjects for signs of joint dysfunction in the thoracic and lumbar spine. The selected segment was marked with an UV invisible mark. A second examiner visualized these marks with an UV lamp and recorded them on acetates for analysis; this process was then repeated an hour later. The distance from the marks to a fixed point was measured and within-day intrarater reliability was calculated using intraclass correlation coefficients (ICCs).


The ICC(1,1) for the thoracic spine was 0.70 (95% confidence interval [CI], 0.27-0.90). In the lumbar spine the ICC(1,1) was 0.96 (95% CI, 0.87-0.99).


This study shows that the lumbar spine joint perceived to be the joint most likely to benefit from a high-velocity low-amplitude thrust can be identified with good within-day reliability in an asymptomatic sample using a defined examination protocol. However, the reliability in identifying a joint exhibiting signs of segmental dysfunction in the thoracic spine was poor.

[Indexed for MEDLINE]

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