Sensitivity for palpating lumbopelvic soft- tissues and bony landmarks and its associated factors: A single-blinded diagnostic accuracy study

Article type: Research Article

Authors: Ferreira, A.P.A.^{a; b} | Póvoa, L.C.^{a; b} | Zanier, J.F.C.^c | Machado, D.C.^c | Ferreira, A.S.^{b; *}

Affiliations: [a] Instituto Brasileiro de Osteopatia, Centro, CEP 22440-901, RJ, Brasil | [b] Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Bonsucesso, CEP 21041-010, RJ, Brasil | [c] Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Vila Isabel, CEP 20551-030, RJ, Brasil

Correspondence: [*] Corresponding author: A.S. Ferreira, Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Praça das Nações 34, Bonsucesso, CEP 21041-010, Rio de Janeiro, RJ, Brasil. Tel.: +5521 38829797 (extension 1015); Fax: +5521 25642244; E-mail: arthur_sf@ig.com.br;arthurde@unisuamdoc.com.br.

Abstract: BACKGROUND: Evidence on the diagnostic performance of palpatory methods and possible confounding factors is scarce. OBJECTIVES: To examine the sensitivity of palpatory methods for location of lumbopelvic landmarks and to assess its association with personal characteristics. METHODS: Eighty-three participants (41 men, 55.6 (16.5) years, 25.9 (4.8) kg/m2 [mean (SD)]) were enrolled in this single-blinded study. Fourteen body and softy-tissue landmarks were sequentially palpated from the spinous process of L4 to the ischial tuberosity. CT-scan images were used to assess what landmark was located. RESULTS: Sensitivity for location was in range 22–86% for soft-tissues and 26–69% for bony landmarks. Reduction in sensitivity was observed from the quadratus lumborum to the inferior and lateral angle of the sacrum (86–26% and 75–33%, left and right sides, respectively). Palpations of L4 and L5 spinous processes were systematically more cephalic than other landmarks. Gender was weakly correlated to almost all landmarks (rp⁢b= 0.333 or weaker). Body mass index was weakly correlated to the accurate location of ILAS and quadratus lumborum, great trochanter, PSIS, and piriformis (rp⁢b=-0.307 or weaker). CONCLUSIONS: Systematic and propagation errors were present using sequential palpatory methods. Palpation in men was more sensitive and higher BMI was associated with lower sensitivity for lumbopelvic landmarks.

Keywords: Palpation, validity, anatomic landmarks, rehabilitation

DOI: 10.3233/BMR-150356

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 735-744, 2017