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A comparison of manual diagnosis with a diagnosis established by a uni-level lumbar anaesthetic block procedure

A comparison of manual diagnosis with a diagnosis established by a uni-level lumbar anaesthetic block procedure
A comparison of manual diagnosis with a diagnosis established by a uni-level lumbar anaesthetic block procedure
SUMMARY. The study was designed to test if a manipulative therapist (MT) using manual examination techniques alone or when accompanied by a verbal response from the subject as to the pain produced, could diagnose the lumbar segmental level responsible for a subjects low back pain and referred pain. The study consisted of prospective and retrospective parts where the MTs manual diagnosis of the symptomatic lumbar segmental level was compared to a segmental level diagnosis attained by subsequent or previous spinal anaesthetic blocks. In the prospective part of the study the MT's manual diagnosis was 94.12% and 52.9% sensitive in detecting the symptomatic lumbar segmental level with verbal and non-verbal subject responses, respectively. In the retrospective part of the study the MTs manual diagnosis was found to be 60.86% and 47.82% sensitive in detecting the symptomatic lumbar segmental level with verbal and non-verbal subject responses, respectively. In the prospective study the MT's manual diagnosis showed 100% and 80% specificity in detecting subjects with no history of low back pain with verbal and non-verbal subject responses, respectively, and 100% and 75% specificity in the retrospective study with verbal and non-verbal subject responses, respectively. Inter-therapist reliability analysis for the recording of passive physiological intervertebral movements (PPIVMs), passive accessory intervertebral movements (PAIVMs) and ‘tissue response’ showed percentage agreement rates ranging from 55% to 99%; 74% to 100% and 43% to 100%, respectively, with weighted kappa values ranging from ?0.11 to 0.32; ?0.15 to 0.24 and kappa values ranging from -0.16 to 0.28, respectively. This study demonstrates that a MT's manual examination when accompanied by a verbal subject response, is highly accurate in detecting the lumbar segmental level responsible for a subjects complaint.
1356-689X
82-87
Phillips, Dean
0294b4eb-9f6d-4033-ba65-9e245c96fdca
Twomey, Lance
6f58f9c7-a15f-4e05-b354-828fad18c4b3
Phillips, Dean
0294b4eb-9f6d-4033-ba65-9e245c96fdca
Twomey, Lance
6f58f9c7-a15f-4e05-b354-828fad18c4b3

Phillips, Dean and Twomey, Lance (1996) A comparison of manual diagnosis with a diagnosis established by a uni-level lumbar anaesthetic block procedure. Manual Therapy, 1 (2), 82-87. (doi:10.1054/math.1996.0254). (PMID:11386842)

Record type: Article

Abstract

SUMMARY. The study was designed to test if a manipulative therapist (MT) using manual examination techniques alone or when accompanied by a verbal response from the subject as to the pain produced, could diagnose the lumbar segmental level responsible for a subjects low back pain and referred pain. The study consisted of prospective and retrospective parts where the MTs manual diagnosis of the symptomatic lumbar segmental level was compared to a segmental level diagnosis attained by subsequent or previous spinal anaesthetic blocks. In the prospective part of the study the MT's manual diagnosis was 94.12% and 52.9% sensitive in detecting the symptomatic lumbar segmental level with verbal and non-verbal subject responses, respectively. In the retrospective part of the study the MTs manual diagnosis was found to be 60.86% and 47.82% sensitive in detecting the symptomatic lumbar segmental level with verbal and non-verbal subject responses, respectively. In the prospective study the MT's manual diagnosis showed 100% and 80% specificity in detecting subjects with no history of low back pain with verbal and non-verbal subject responses, respectively, and 100% and 75% specificity in the retrospective study with verbal and non-verbal subject responses, respectively. Inter-therapist reliability analysis for the recording of passive physiological intervertebral movements (PPIVMs), passive accessory intervertebral movements (PAIVMs) and ‘tissue response’ showed percentage agreement rates ranging from 55% to 99%; 74% to 100% and 43% to 100%, respectively, with weighted kappa values ranging from ?0.11 to 0.32; ?0.15 to 0.24 and kappa values ranging from -0.16 to 0.28, respectively. This study demonstrates that a MT's manual examination when accompanied by a verbal subject response, is highly accurate in detecting the lumbar segmental level responsible for a subjects complaint.

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Published date: March 1996
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 400733
URI: https://eprints.soton.ac.uk/id/eprint/400733
ISSN: 1356-689X
PURE UUID: c30cb706-9e3f-43dc-af55-b7be3015ede2
ORCID for Dean Phillips: ORCID iD orcid.org/0000-0001-8422-4340

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Date deposited: 23 Sep 2016 10:49
Last modified: 06 Jun 2018 13:04

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Author: Dean Phillips ORCID iD
Author: Lance Twomey

University divisions

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