The validity of lumbo-pelvic landmark palpation by manual practitioners: A systematic review. (March 2021)

• Record Type: Journal Article
• Authors: Alexander, Natalie; Rastelli, Alan; Webb, Tamsyn; Rajendran, Dévan
• Is Part Of: International journal of osteopathic medicine. Number 39(2021)
• Page Start: 10
• Page End: 20
• Publication Date: 2021-03
• Subjects: Accuracy -- Lumbar spine -- Lumbo-pelvic -- Manual practitioner -- Palpation -- Pelvis -- Reference standard -- Validity; Osteopathic medicine -- Periodicals; Osteopathic Medicine -- Periodicals; 615.53305
• DOI: 10.1016/j.ijosm.2020.10.008
• Languages: English
• ISSNs: 1746-0689

Abstract

Abstract: Objective: Lumbo-pelvic landmark palpation is widely used by manual practitioners as part of a clinical assessment. However, research has not clearly described or established the validity of landmark palpation as a diagnostic tool; we aimed to analyse and synthesise data on the validity of lumbo-pelvic landmark palpation compared to an imaging modality reference standard. Methods and results: Nine studies met the inclusion criteria (43 practitioners assessing 364 subjects). Mean palpatory accuracy ranged from 42 to 71%; four studies reported kappa values, ranging from 0.20 (no agreement) to 0.81 (strong); two studies could not be directly compared. The use of multiple palpation techniques improved palpation accuracy, however, no specific technique or technique combination was more accurate than another. Methodological quality was assessed using the QUADAS-2 check-list tool; eight studies were rated as having a risk of bias and/or concerns regarding applicability. Conclusion: The use of lumbo-pelvic landmark palpation does not reach clinically acceptable levels of validity; however, heterogeneity in the included studies' methods and data reporting limited between trial comparisons. These results accord with other reviews and suggest the necessity of a shift away from over-reliance on landmark palpation to align manual therapy with practise guidelines. HIGHLIGHTS: Lumbo-pelvic landmark palpation (LPLP) has sub-threshold validity scores. These scores indicate that LPLP lacks necessary validity for clinical practice. Research on LPLP suffers with heterogeneity and methodological issues. Aligning with nsLBP practice guidelines will reduce practitioners' reliance on LPLP.