The assessment of pelvic landmarks using palpation: A reliability study of undergraduate students

BackgroundThe use of palpation to diagnose the movement and positional components of sacroiliac joint (SIJ) dysfunction is commonly taught within osteopathy. However, concerns have been raised about the reliability of such protocols.ObjectiveThe aim of this study was to investigate the inter-rater reliability of four traditional static palpation tests based upon the Frank Mitchell Sr biomechanical model of pelvic movement as taught and used to diagnose and treat positional pelvic joint dysfunction.DesignA small scale inter-rater reliability study.MethodsTwenty third-year students with similar levels of training in the Mitchell Model examined and scored four asymptomatic subjects for positional and movement dysfunctions. The examiners were blinded to each other and performed all four diagnostic tests. Scores were recorded and analysed for inter-rater reliability using Fleiss’ Kappa (Fk), Agreement Coefficient 1 (AC1) and Kendall’s coefficient of concordance.ResultsAll SIJ test scores produced Fk results below 0.4 (−0.0476 to 0.0330), indicating “Poor” inter-rater reliability; values of Fk ≥ 0.4 are considered to be clinically reliable. In addition, AC1 results ranged from −0.04 to 0.189. Kendall’s coefficients of concordance were not significant for inter-rater agreement (p = 0.06 to p 0.89).ConclusionThis small study demonstrated “Poor” inter-rater reliability of the Mitchell Model used to diagnose pelvic SIJ dysfunction. These findings are consistent with other studies in this field. It is suggested that the inclusion of this osteopathic model within curricula be reviewed forthwith.