title: Paraspinal skin temperature patterns: an interexaminer and intraexaminer reliability study.
abstract: BACKGROUND
  Paraspinal thermography is used by chiropractors as an aid in assessing the presence of vertebral subluxation. Few reliability studies have been carried out, with mixed results. Digital infrared scanning equipment is now available with location tracking that may enhance reproducibility. Digitized scans enable a computer-aided interpretation of thermographic patterns.
  
  
  OBJECTIVE
  To assess the ability of examiners to reproduce thermal patterns.
  
  
  METHODS
  Repeated measures with 2 examiners assessing the same patient on 2 occasions. Thirty asymptomatic students served as subjects.
  
  
  METHODS
  A TyTron C-3000 handheld thermographic scanner interfaced to a Microsoft Windows compatible personal computer was used for all recordings. Each examiner recorded 2 scans on each patient. It took an average of 3 minutes to complete all 4 scans. Data were exported to a spreadsheet for initial analysis, then SPSS was used for calculation of intraclass correlation coefficients (ICC). Since the starting and stopping points of scans were not always the same, care was taken to align scans visually, using well-distinguished peaks on the charts as guides. Scans were cropped to remove artifacts that might have occurred at the beginning and end of the scans. Intraexaminer and interexaminer ICCs were calculated.
  
  
  RESULTS
  Skin temperatures ranged from 35.4 degrees C to 30.0 degrees C over all scans. The average temperatures changed little from the first to the last scans, indicating that subjects' overall skin temperatures were stable during the scanning procedure. Intraexaminer ICCs ranged from 0.953 to 0.984. The left and right channel data show slightly higher congruence than the Delta channel. The interexaminer reliability coefficients ranged from 0.918 to 0.975. Again, the Delta channel shows slightly less reliability, although the ICCs were quite high for all channels.
  
  
  CONCLUSIONS
  Intraexaminer and interexaminer reliability of paraspinal thermal scans using the TyTron C-3000 were found to be very high, with ICC values between 0.91 and 0.98. Changes seen in thermal scans when properly done are most likely due to actual physiological changes rather than equipment error.
authors.affiliation: Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803, USA. edward.owens@palmer.edu
authors.forename: Edward F
authors.initials: EF
authors.lastname: Owens
authors.forename: John F
authors.initials: JF
authors.lastname: Hart
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Donofrio
authors.forename: Jason
authors.initials: J
authors.lastname: Haralambous
authors.forename: Eric
authors.initials: E
authors.lastname: Mierzejewski
mesh_terms: D000328:Adult; D002684:Chiropractic / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012016:Reference Values; D015203:Reproducibility of Results; D012107:Research Design; D012680:Sensitivity and Specificity; D012881:Skin Temperature; D013122:Spinal Diseases / Q000175:diagnosis; D013814:Thermal Conductivity; D013817:Thermography / Q000295:instrumentation / Q000379:methods