title: The effects of experience on the inter-reliability of osteopaths to detect changes in posterior superior iliac spine levels using a hidden heel wedge.
abstract: BACKGROUND
  The use of palpation to diagnose musculoskeletal dysfunction is commonly taught within osteopathy and other manual therapies. However the clinical tests used to detect sacroiliac joint dysfunction have not shown good reliability.
  
  
  OBJECTIVE
  To investigate the inter-examiner reliability of osteopaths to detect asymmetries of the posterior superior iliac spine (PSIS), and to determine if inter-examiner reliability was affected by the level of practitioner experience.
  
  
  METHODS
  Fifteen final year osteopathic students (n = 15), fifteen third year osteopathic students (n = 15) and ten experienced osteopaths (n = 10) manually palpated the levels of the PSIS in one model nine consecutive times. A hidden 5 mm heel wedge was used to alter the height of the PSIS which was hidden from the examiners. Scores were analysed using Fleiss Kappa (Fκ) statistics and one way analysis of variance on ranks (ANOVA).
  
  
  RESULTS
  All three groups produced Fκ results below 0.4 (0.025-0.065), indicating poor inter-examiner reliability. Fκ values less than 0.4 are considered to be clinically unreliable. ANOVA testing did not show any significant difference between groups.
  
  
  CONCLUSIONS
  This study showed 'poor' inter-examiner reliability in detecting asymmetries of the PSIS. This is in accordance with other studies in the field. It is suggested that the inclusion of this osteopathic model within osteopathic education should be reviewed.
authors.affiliation: British College of Osteopathic Medicine, Research Department, London, United Kingdom.
authors.forename: Claire
authors.initials: C
authors.lastname: Sutton
authors.forename: Lazarus
authors.initials: L
authors.lastname: Nono
authors.forename: Ross G
authors.initials: RG
authors.lastname: Johnston
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Thomson
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D005260:Female; D006365:Heel; D006801:Humans; D007085:Ilium; D007592:Joint Diseases / Q000175:diagnosis*; D008159:Lumbar Vertebrae; D026201:Musculoskeletal Manipulations / Q000193:education / Q000592:standards / Q000706:statistics & numerical data; D015588:Observer Variation; D055360:Osteopathic Physicians / Q000193:education* / Q000592:standards / Q000706:statistics & numerical data*; D010173:Palpation / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D016544:Patient Simulation; D015203:Reproducibility of Results; D012446:Sacroiliac Joint