Maintenance and improvement of interobserver reliability of osteopathic palpatory tests.

To the Editor: We applaud the efforts by Brian F. Degenhardt, DO, and colleagues,1 published in the October 2010 JAOA—The Journal of the American Osteopathic Association, to document maintenance and improvement in the interexaminer reliability of osteopathic physicians’ palpatory skills. Because reliable palpatory diagnosis is fundamental to osteopathic diagnosis and treatment, this subject matter is an important area to explore. Furthermore, the demonstration of interexaminer reliability is a prelude to an objective basis for description of somatic dysfunction. In diagnosis and treatment, osteopathic physicians examine tissue texture and drag, structural asymmetry, tenseness or tightness of underlying tissues, pain response to pressure, and response to introduced motion. As a profession, we must work to reconcile the diversity of these various osteopathic diagnostic and treatment approaches. In 1982, Johnston et al2 described consistency of palpatory findings with a high degree of accuracy and interexaminer reliability within a select population. As reported in the study by Degenhardt et al,1 careful training and hand placement with periodic recalibration can result in credible diagnostic accuracy. These new findings resonate well with those published in 1982.2 In a world of increasing demands for evidence-based medicine, this type of evidence is invaluable to the osteopathic medical profession.