title: Motion palpation used as a postmanipulation assessment tool for monitoring end-feel improvement: a randomized controlled trial of test responsiveness.
abstract: OBJECTIVE
  A tenet of motion palpation theory is the ability to confirm postadjustive segmental end-feel improvement (EFI). Only one previous trial has evaluated the responsiveness of EFI; this was a study of the thoracic spine. The purpose of this study was to evaluate the responsiveness of postadjustive end-feel for evaluating improvement in putative segmental spinal motion restriction after spinal manipulative therapy (SMT) of the cervical spine.
  
  
  METHODS
  A prospective, blinded, randomized placebo-controlled pilot trial was conducted with 20 symptomatic and 10 asymptomatic participants recruited from a chiropractic teaching clinic. The treatment group received SMT, and the control group received placebo detuned ultrasound. Responsiveness was evaluated as the etiologic fraction (% of cases with EFI attributable to SMT) and as the sensitivity and specificity of change.
  
  
  RESULTS
  For the entire sample, the etiologic fraction was 63% (P = .002), sensitivity was 93%, and specificity was 67%. For symptomatic participants, a strong relationship appeared to exist between receiving SMT and EFI (etiologic fraction = 78%, P = .006; sensitivity = 90%; specificity = 80%). A strong relationship was not found for asymptomatic participants (etiologic fraction = 40%, P = .444; sensitivity = 100%; specificity = 40%), where EFI was recorded frequently, whether participants received SMT or detuned ultrasound.
  
  
  CONCLUSIONS
  The findings of this study showed that motion palpation of end-feel assessment appears to be a responsive postmanipulation assessment tool in the cervical spine for determining whether perceived motion restriction found before treatment improves after SMT. This observation may be limited to symptomatic participants.
authors.affiliation: Chiropractic Department, Durban University of Technology, Kwazulu Natal, South Africa. ektal@dut.ac.za
authors.forename: Ekta
authors.initials: E
authors.lastname: Lakhani
authors.forename: Brian
authors.initials: B
authors.lastname: Nook
authors.forename: Mitchell
authors.initials: M
authors.lastname: Haas
authors.forename: Aadil
authors.initials: A
authors.lastname: Docrat
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods; D010147:Pain Measurement; D010173:Palpation / Q000379:methods*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012684:Sensory Thresholds / Q000502:physiology*; D016037:Single-Blind Method; D013019:South Africa; D013122:Spinal Diseases / Q000175:diagnosis / Q000534:rehabilitation*; D016896:Treatment Outcome; D055815:Young Adult