title: Intraobserver reliability of cranial strain patterns as evaluated by osteopathic physicians: a pilot study.
abstract: BACKGROUND
  Few studies of inter- or intraobserver reliability have focused on evaluations of cranial strain patterns.
  
  
  OBJECTIVE
  To determine whether substantial intraobserver reliability can be achieved by osteopathic physicians (DOs) using common palpatory tests to diagnose cranial dysfunction.
  
  
  METHODS
  Forty-eight subjects were divided into three diagnostic groups, categorized as those with asthma, headaches, or neither asthma nor headaches (ie, healthy control group). Two blinded DO examiners separately evaluated approximately 8 subjects from each group (4 subjects per session), conducting diagnostic tests for cranial rhythmic impulse (CRI) rate, cranial strain patterns, and quadrants of restriction.
  
  
  RESULTS
  Overall, among the three diagnostic procedures, cranial strain patterns showed the highest intraobserver reliability (kappa=0.67). The highest intraobserver reliability was achieved in cranial strain patterns for the control group (kappa=0.82), followed by the headache (kappa=0.67) and asthma (kappa=0.52) groups. Diagnoses of the left anterior quadrant of restriction also showed substantial intraobserver reliability for the headache and control groups (kappa=0.60 and 0.61, respectively). Diagnoses of three quadrants of restriction showed moderate overall intraobserver reliability (kappa=0.44-0.52), while the left posterior quadrant had only fair overall intraobserver reliability (kappa=0.33).
  
  
  CONCLUSIONS
  Osteopathic physicians can obtain substantial intraobserver reliability when diagnosing cranial strain patterns in healthy subjects as well as those with asthma or headache. However, results are less promising for diagnoses of CRI and quadrants of restriction.
authors.affiliation: Department of Osteopathic Manipulative Medicine, Kirksville College of Osteopathic Medicine-A.T. Still University, 800 W Jefferson St, Kirksville, MO 63501-1443, USA. khalma@atsu.edu
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Halma
authors.forename: Brian F
authors.initials: BF
authors.lastname: Degenhardt
authors.forename: Karen T
authors.initials: KT
authors.lastname: Snider
authors.forename: Jane C
authors.initials: JC
authors.lastname: Johnson
authors.forename: M Schaun
authors.initials: MS
authors.lastname: Flaim
authors.forename: Danielle
authors.initials: D
authors.lastname: Bradshaw
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D005260:Female; D006261:Headache / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D015588:Observer Variation; D010173:Palpation; D010865:Pilot Projects; D015203:Reproducibility of Results; D012886:Skull / Q000503:physiopathology*; D055815:Young Adult