Cranial palpation pressures used by osteopathy students: effects of standardized protocol training.

CONTEXT Descriptions of subtle palpatory perceptions in osteopathic cranial palpation can be misperceived by students. Thus, adequate dissemination and replication of cranial palpatory techniques is challenging for osteopathy students. OBJECTIVE To evaluate the effects of standardized protocol training on cranial palpation of the frontomalar suture. METHODS Fourth-year osteopathy students from the European Center for Osteopathic Higher Education in Paris, France, were recruited and randomly divided into three groups. Students in the study group received instruction in a standardized protocol for palpatory assessment of the frontomalar suture; students in the control group did not receive instruction; and the remaining students acted as subjects. A specialized force sensor was placed on the skin covering the left frontomalar suture of each subject. Student practitioners were instructed to palpate subjects' left frontomalar suture using the customary pressure described for evaluation and treatment of somatic dysfunction of the cranium. Pressure measurements were exported to a laptop computer. RESULTS Twelve students were in each group. Student practitioners' palpation pressures ranged from 0.19 to 1.12 N/cm(2), while mean palpation pressures for each test ranged from 0.27 to 0.98 N/cm(2). The mean (SD) palpation pressure in the study group and control group was 0.55 N/cm(2) (0.16 N/cm(2)) and 0.53 N/cm(2) (0.15 N/cm(2)), respectively. There was no statistically significant difference in mean palpation pressures used by the two groups. Substantial variation in test performance was noted in both groups. CONCLUSION Palpatory training was ineffective in improving student practitioners' precision of cranial palpation performance. Quantitative feedback of palpation pressures during training may improve outcomes. To our knowledge, data on palpation pressures used during osteopathic cranial manipulation have not been reported previously in the medical literature.