Show simple item record

dc.contributor.advisorKretzmann, Heidi
dc.contributor.authorManley, Charlene Anne
dc.date.accessioned2010-10-01T11:50:58Z
dc.date.available2012-09-01T22:20:06Z
dc.date.issued2010
dc.identifier.other331124
dc.identifier.urihttp://hdl.handle.net/10321/544
dc.descriptionDissertation submitted in partial fulfilment of the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2010.en_US
dc.description.abstractMotion palpation is an examination technique commonly used by chiropractors to identify a manipulable subluxation prior to manipulation. In order for its continued use, it must be validated. Many studies conducted on motion palpation’s inter-examiner reliability in the spine have shown it to be below average, however only a few studies have addressed its use in the extremity joints. No inter-examiner reliability studies on motion palpation were found for the elbow, let alone the symptomatic elbow with regards to chronic lateral epicondylalgia, a common disorder of the elbow effectively treated by the use of manipulation. Objectives The objectives of this study were to determine the inter-examiner reliability of motion palpation of the elbow for the asymptomatic elbow and the symptomatic elbow with regards to chronic lateral epicondylalgia. It also aimed to compare these results to determine any difference in reliability, the number of manipulable subluxations and the presence of manipulable subluxations in particular directions, between the two groups. Method Twenty participants (n=40 elbows) between the ages of 18 to 65, with one asymptomatic and one symptomatic elbow (chronic lateral epicondylalgia) were examined by three final year masters chiropractic students for the presence of manipulable subluxations in end play, using only motion palpation. The examiners were pre-trained, randomised and blinded. Each examiner individually motion palpated both elbows on each participant, in nine directions of motion palpation, incorporating the humeroulnar and proximal radioulnar joints. They were also required to identify which elbow was symptomatic. Fleiss’ kappa and percentage agreement (perfect percentage agreement and mean percentage agreement) were used to measure reliability. Paired non parametric Wilcoxon signed ranks compared the difference between both groups and McNemar’s chi square tests assessed the percentage of correctly identified symptomatic elbows for each examiner. A p value <0.05 was considered statistically significant. iv Results The asymptomatic elbows showed a poor range of kappa results, from 0.0683 to -0.1321, with a mean kappa of -0.0664. Perfect percentage agreement was 50% to 85% and mean percentage agreement was 83.30% to 94.99%. The symptomatic elbows’ kappa values ranged between -0.2691 to 0.4034 with a mean kappa of -0.0028. The humeroulnar medial to lateral direction of motion palpation had a moderate kappa value of 0.4034. Perfect percentage agreement ranged from 10% to 85% and mean percentage agreement from 69.94% to 94.99%. There was an insignificant difference in kappa values between the two groups (p=0.260), although there was a trend towards the asymptomatic kappa values being lower than the symptomatic values. The difference between symptomatic and asymptomatic elbows was significant in proximal radioulnar posterior to anterior glide in pronation (p=0.013), as well as proximal radioulnar rotation of the radial head on the ulna (p=0.008). Overall, more manipulable subluxations were found in the symptomatic elbows than in the asymptomatic elbows. The examiners correctly identified the symptomatic elbow in 65% to 90% of participants (p=1.000). Conclusions and Recommendations In conclusion, the inter-examiner reliability of motion palpation in the asymptomatic elbow was poor, and in the symptomatic elbow (chronic lateral epicondylalgia), poor to moderate. There was an insignificant difference in reliability between the two groups, although more manipulable subluxations were found in the symptomatic elbows overall. These were mainly in proximal radioulnar posterior to anterior glide in pronation, as well as proximal radioulnar rotation of the radial head on the ulna, two directions of motion that form part of Mills’ manipulation. This study also found that examiners were able to identify the symptomatic elbows with the use of motion palpation. It is recommended that future research continue from this study in assessing the identification and presence of manipulable subluxations in all the extremity joints. However the methodological problems with the statistical analysis need to be addressed.en_US
dc.format.extent119 pen_US
dc.language.isoenen_US
dc.subject.lcshChiropracticen_US
dc.subject.lcshElbow--Wounds and injuries--Diagnosisen_US
dc.subject.lcshElbow--Wounds and injuries--Chiropractic treatmenten_US
dc.subject.lcshPalpationen_US
dc.subject.lcshManipulation (Therapeutics)en_US
dc.titleThe inter-examiner reliability of motion palpation in chronic lateral epicondylalgia and asymptomatic elbowsen_US
dc.typeThesisen_US
dc.dut-rims.pubnumDUT-002315


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record