Palpation for muscular tenderness in the anterior chest wall: an observer reliability study.
OBJECTIVE
To asses the interobserver and intraobserver reliability (in terms of day-to-day and hour-to-hour reliability) of palpation for muscular tenderness in the anterior chest wall.


METHODS
A repeated measures designs was used.


METHODS
Department of Nuclear Medicine, Odense University Hospital, Denmark.


METHODS
Two experienced chiropractors examined 29 patients and 27 subjects in the interobserver part, and 1 of the 2 chiropractors examined 14 patients and 15 subjects in the intraobserver studies.


METHODS
Palpation for muscular tenderness was done in 14 predetermined areas of the anterior chest wall with all subjects sitting. Each dimension was rated as absent or present for tenderness or pain for each location. All examinations were carried out according to a standard written procedure.


RESULTS
Based on a pooled analysis of data from palpation of the anterior chest wall, we found kappa values of 0.22 to 0.31 for the interobserver reliability. For the intraobserver reliability, we found kappa values of 0.21 to 0.28 for the day-to-day reliability and 0.44 to 0.49 for the hour-to-hour reliability.


CONCLUSIONS
Our results indicated great variations between experienced chiropractors palpating for intercostal tenderness or tenderness in the minor and major pectoral muscles in a population of patients with and without chest pain. This may hamper the ability of clinicians to diagnose and classify the musculoskeletal component of chest pain if based exclusively on palpation of the anterior chest wall.
Department of Nuclear Medicine, Odense University Hospital, Denmark. h.wulff@nikkb.dk
Henrik Wulff
HW
Christensen
Werner
W
Vach
Claus
C
Manniche
Torben
T
Haghfelt
Lisbet
L
Hartvigsen
Poul Flemming
PF
Høilund-Carlsen
D016022:Case-Control Studies; D002983:Clinical Competence / Q000592:standards; D003327:Coronary Disease / Q000175:diagnosis; D003718:Denmark; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods; D008875:Middle Aged; D015588:Observer Variation; D010146:Pain / Q000175:diagnosis* / Q000503:physiopathology; D010147:Pain Measurement / Q000379:methods; D010173:Palpation / Q000379:methods; D011187:Posture; D011237:Predictive Value of Tests; D015995:Prevalence; D015203:Reproducibility of Results; D013122:Spinal Diseases / Q000175:diagnosis* / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000503:physiopathology*; D035441:Thoracic Wall / Q000503:physiopathology*; D013997:Time Factors