title: Locating the Seventh Cervical Spinous Process: Development and Validation of a Multivariate Model Using Palpation and Personal Information.
abstract: The aim of this study was to develop and validate a multivariate prediction model, guided by palpation and personal information, for locating the seventh cervical spinous process (C7SP).
  
  
  
  A single-blinded, cross-sectional study at a primary to tertiary health care center was conducted for model development and temporal validation. One-hundred sixty participants were prospectively included for model development (n = 80) and time-split validation stages (n = 80). The C7SP was located using the thorax-rib static method (TRSM). Participants underwent chest radiography for assessment of the inner body structure located with TRSM and using radio-opaque markers placed over the skin. Age, sex, height, body mass, body mass index, and vertex-marker distance (DV-M) were used to predict the distance from the C7SP to the vertex (DV-C7). Multivariate linear regression modeling, limits of agreement plot, histogram of residues, receiver operating characteristic curves, and confusion tables were analyzed.
  
  
  
  The multivariate linear prediction model for DV-C7(in centimeters) was DV-C7= 0.986DV-M+ 0.018(mass) + 0.014(age) - 1.008. Receiver operating characteristic curves had better discrimination of DV-C7(area under the curve = 0.661; 95% confidence interval = 0.541-0.782; P = .015) than DV-M(area under the curve = 0.480; 95% confidence interval = 0.345-0.614; P = .761), with respective cutoff points at 23.40 cm (sensitivity = 41%, specificity = 63%) and 24.75 cm (sensitivity = 69%, specificity = 52%). The C7SP was correctly located more often when using predicted DV-C7in the validation sample than when using the TRSM in the development sample: n = 53 (66%) vs n = 32 (40%), P < .001.
  
  
  
  Better accuracy was obtained when locating the C7SP by use of a multivariate model that incorporates palpation and personal information.
authors.affiliation: Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil.
authors.forename: Ana Paula A
authors.initials: APA
authors.lastname: Ferreira
authors.affiliation: Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil.
authors.forename: Luciana C
authors.initials: LC
authors.lastname: Póvoa
authors.affiliation: Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil.
authors.forename: José F C
authors.initials: JFC
authors.lastname: Zanier
authors.affiliation: Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil. Electronic address: arthurde@unisuamdoc.com.br.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009333:Neck / Q000000981:diagnostic imaging; D010173:Palpation / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D016037:Single-Blind Method
keywords: Cervical Vertebrae; Diagnostic Errors; Palpation; Physical Examination; Physical Therapy Specialty; Rehabilitation