Musculoskeletal chest pain in patients with stable angina pectoris – diagnosis and treatment

Objective: To assess the intraobserver reliability (in terms of hour-to-hour and day-to-day reliability) and the interobserver reliability with 3 palpation procedures for the detection of spinal biomechanic dysfunction in the upper 8 segments of the thoracic spine. Design: A repeated-measures design was used in all substudies. Setting: Department of Nuclear Medicine, Odense University Hospital, Denmark. Participants: Two chiropractors examined 29 patients and 27 subjects in the interobserver part and 1 chiropractor examined 14 patients and 15 subjects in the intraobserver studies. Intervention: Three types of palpation were performed: Sitting motion palpation and prone motion palpation for biomechanic dysfunction and paraspinal palpation for tenderness. Each dimension was rated as “absent” or “present” for each segment. All examinations were performed according to a standard written procedure. Results: Using an “expanded” definition of agreement that accepts small inaccuracies ( 1 segment) in the numbering of spinal segments, we found—based on the pooled data from the thoracic spine—kappa values of 0.59 to 0.77 for the hour-to-hour and the day-to-day intraobserver reliability with all 3 palpation procedures. Kappa coefficients were 0.24 and 0.22 for the interobserver reliability with prone and sitting motion palpation and 0.67 and 0.70, respectively, with paraspinal palpation for tenderness. Conclusion: With expanded agreement we found good hour-to-hour and day-to-day intraobserver reliability with all 3 palpation procedures and good interobserver reliability for paraspinal tenderness. The interobserver reliability was unacceptably poor with prone and sitting motion palpation. (J Manipulative Physiol Ther 2002;25:285-92) Key Indexing Terms: Observer Variation; Reliability; Chest Pain; Thoracic Spine; Chiropractic Department of Nuclear Medicine, Odense University Hospital, Denmark, Department of Cardiology, Odense University Hospital, Denmark, Department of Statistics and Demography, University of Southern Denmark, Denmark, Back Clinic, Ringe Hospital, Denmark. Private practice of chiropractic. This study was supported by the Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark, and the Foundation for the Advancement of Chiropractic Research and Postgraduate Education, Denmark. Submit reprint requests to: Henrik Wulff Christensen, DC, MD, Department of Nuclear Medicine, Odense University Hospital, Sdr. Bouldvard 29, DK-5000 Odense C, Denmark (e-mail: h.wulff@ nikkb.dk). Paper submitted February 13, 2001; in revised form March 15, 2001. Copyright © 2002 by JMPT. 0161-4754/2002/$35.00 0 76/1/124424 doi:10.1067/mmt.2002.124424