[Reliability of manual medical examination techniques of the cervical spine. Study of quality assurance in manual diagnosis].
OBJECTIVE
Chiropractic techniques are of particular importance for the examination of the cervical spine. The aim of this study was to assess interexaminer reliability of examination techniques of the cervical spine in subjects with and without musculoskeletal distortions of the neck. The interrater method was used with five independent examiners.


METHODS
Twenty patients suffering from neck diseases and 20 asymptomatic subjects of similar age and gender were randomized and assessed by five examiners blind to patient histories. Statistical analysis was carried out using multiple logistic regression and the calculation of kappa.


RESULTS
Compared to asymptomatic subjects, patients experienced pain significantly often when pressure was applied to the cervical zygapophysial joints and the superficial neck muscles (p < or = 0.05 and p < or = 0.01). In addition, segmental function tests induced kinesialgia significantly more often in patients than in asymptomatic subjects (p < or = 0.05 and p < or = 0.01). A significant relationship was not found between the patient's health status and the findings from muscle palpation and functional examination of the motion segments. The assessment of agreement within examiners beyond chance had to be calculated, aside from for few exceptions, little to moderate (0.2 < kappa < or = 0.6).


CONCLUSIONS
Chiropractic techniques are an essential part of every examination of the cervical spine. The clinical impact has not been scientifically established until up to now. Based on our findings and literature, we conclude that interexaminer reliability of manual diagnosis in the examination of the cervical spine should be improved by standardizing the examination process and setting guidelines for documentation and evaluation criteria. Controlled and frequently repeated training sessions also contribute to the reproducibility of findings from manual examinations.
Schöps
P
P
Klinik und Poliklinik für Physikalische Medizin und Rehabilitation, Klinikum der Ludwig-Maximilians-Universität München.
Pfingsten
M
M
Siebert
U
U
D000328:Adult; D002574:Cervical Vertebrae; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal; D008875:Middle Aged; D009334:Neck Muscles / Q000293:injuries; D015588:Observer Variation; D012680:Sensitivity and Specificity; D013122:Spinal Diseases / Q000175:diagnosis* / Q000209:etiology; D013180:Sprains and Strains / Q000175:diagnosis