Abstract
M.Tech.
Palpation is a skill taught to manual practitioners on a daily basis. This skill is used by health care professionals, including chiropractors, to examine patients complaining of spinal pain. It is the chiropractor’s responsibility to have the ability and experience to locate and identify individual spinal levels, as well as any changes in tissues affected, to accurately diagnose and treat their patients (Downey, Taylor and Niere, 1999).
The inability of the therapist to have this skill, can lead to incorrect diagnosis, and in turn, incorrect treatment being provided (Downey et al, 1999).
Numerous research studies have been conducted to determine how significant clinical experience is in terms of reliable palpation being achieved. Researchers such as Koran (1975) and McConnell (1980), Simmonds and Kumar (1993), McKenzie and Taylor (1997), Burton and Edwards (1990) have all been unable to support the hypothesis that experience plays a significant role in improving inter-examiner or intra-examiner reliability in their research studies.
This study aims to determine the inter-examiner reliability of locating the spinous process of the seventh cervical vertebra by palpation, and to explore the role that clinical experience plays upon efficacy.
Thirty participants were recruited to become part of this study. The 6 examiners chosen consisted of two 5th year and two 6th year chiropractic students as well as two qualified chiropractors. A random allocation was used which ensured that every participant was examined by 3 examiners, each from the different clinical experiences. Examiners were provided with instructions before proceeding with the study. Each participant was palpated to locate the C7 spinous processes and once located, the level was marked with a UV pen. The UV marks were located by illuminating with a UV light and these were replaced with metal markers. Each participant was then positioned to have both the AP and lateral x-ray views done.
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Once all participants were x-rayed, horizontal lines were drawn through the C7 spinous processes and metal markers on both the AP and lateral x-ray films. Distances from the lines through the spinous processes to each metal marker, were measured. The provided statistical tests were used to analyse the data. According to the Pearson Chi-square test used, there was no statistically significant difference amongst all examiners on the ability to correctly palpate, locate and mark the C7 spinous processes. Results further showed that the 6th year students correctly identified more levels on the AP x-ray films, whilst both 6th year students and the qualified chiropractors correctly located more and equal levels on the lateral x-ray films.
This study showed that there were difficulties amongst all examiners across all levels of clinical experience and this important role of experience is therefore not fully understood.