title: Posterior-anterior(PA) pressure Puffin for measuring and treating spinal stiffness: Mechanism and repeatability.
abstract: BACKGROUND
  Posterior-anterior (PA) pressure technique is widely used for assessing and treating spinal segments. PA pressure is manually applied and stiffness is subjectively assessed. The method has been deemed unreliable and is associated with occupational strain.
  
  
  OBJECTIVE
  To introduce a new ergonomically designed hand-held device measuring spinal stiffness, and to assess its repeatability.
  
  
  METHODS
  Quasi experimental study.
  
  
  METHODS
  A convenience sample of 30 university students, 20-30 years old was used. The participants were tested two consecutive days by two physical therapy students using the new device; the PA pressure Puffin. The spinal segments under study were L1, Th12, Th7 and Th6 which all were tested three times with 9 kg force by both testers, both days. Intra-class correlation coefficients (ICC3,k) were used to assess intra- and inter-tester repeatability and analysis of variance with alpha-level at 0.05 was used to assess differences in joint mobility at the four segments measured. Linear regression analyses were used to assess repeatability.
  
  
  RESULTS
  Inter-tester and intra-tester coefficients (ICCs) ranged from 0.88 to 0.97 and from 0.83 to 0.97, respectively. There was no significant difference in displacement between Th6 and Th7 but all other joints were significantly different from each other. Displacement was always significantly greater the second day compared with day one (p < 0.05).
  
  
  CONCLUSIONS
  This close to final prototype of the PA pressure Puffin measures segmental spinal stiffness and its ergonomically designed handle provides a promising tool for physical therapists applying PA pressure. Further research is needed for validation and reliability assessments.
authors.affiliation: Department of Physical Therapy, Faculty of Medicine, University of Iceland, Reykjavík, Iceland. Electronic address: sigrunvb@hi.is.
authors.forename: Sigrún Vala
authors.initials: SV
authors.lastname: Björnsdóttir
authors.affiliation: Innovation Centre Iceland, Reykjavík, Iceland.
authors.forename: Geir
authors.initials: G
authors.lastname: Guðmundsson
authors.affiliation: Innovation Centre Iceland, Reykjavík, Iceland.
authors.forename: Guðjón Atli
authors.initials: GA
authors.lastname: Auðunsson
authors.affiliation: Innovation Centre Iceland, Reykjavík, Iceland.
authors.forename: Jón
authors.initials: J
authors.lastname: Matthíasson
authors.affiliation: Landspítali - The National University Hospital of Iceland, Reykjavík, Iceland.
authors.forename: María
authors.initials: M
authors.lastname: Ragnarsdóttir
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena / Q000502:physiology; D006804:Ergonomics / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007055:Iceland; D017116:Low Back Pain / Q000175:diagnosis* / Q000534:rehabilitation*; D008159:Lumbar Vertebrae / Q000503:physiopathology*; D008297:Male; D020393:Manipulation, Spinal / Q000295:instrumentation*; D009068:Movement / Q000502:physiology*; D011312:Pressure; D015203:Reproducibility of Results; D013334:Students; D014495:Universities; D055815:Young Adult
keywords: Ergonomic; Posterior–anterior pressure; Repeatability; Spinal stiffness