Since 2020, we have spent a lot of time covering studies reporting impressive outcomes in mental health, cognition, adaptability, immune function, physical resilience. We have such a particular interest in this area of chiropractic research that we launched the ASRF Case Report Project in 2021 to see more case reports published in this area. Case reports continue to offer up clinically relevant insight into what goes on in the symptomatology of real people who are undergoing chiropractic care, and this is of immense value to both the clinician understanding this and the patient receiving the benefits of the work chiropractors do in this area. To complement the case report work and to add further evidence to what we experience clinically, larger studies and clinical trials are required. That is why a new study recently funded by the ASRF is an exciting addition to the evidence bank.
Central to the chiropractic mission is analysing, detecting and reducing subluxation. Thus, it is essential that we look at the reliable detection of subluxation. While previous studies have examined a common battery of tests in relation to this, a new study has examined inter-rater reliability of a specific technique – the ABC technique that focuses on manual correction of posture from anterior to posterior [1, 2].
This study takes us out of the focus on symptoms and emphasizes what is central to chiropractic: chiropractors care for the nervous system. To effectively impact the nervous system, chiropractors need to be able to analyse, detect and adjust subluxation – and in order to appropriately do this, they need to be able to reliably identify areas of subluxation. This can be done a number of ways using pain, asymmetry, relative range of motion, thermography, the list goes on.
In introducing the topic and study rationale, the author discussed the fact that, generally speaking, more favourable evidence exists for procedures that take a direct measure of the presumptive site of care, such as methods involving pain provocation upon palpation or localised tissue examination [2].
The Study
Enter Advanced Biostructural Correction (ABC). ABC is a manual therapy method practised by 1.5% of all chiropractors registered in Australia. 94 registered chiropractors are members of Advanced Biostructural Correction Australasia, the association representing ABC. As a part of the ABC protocol, the objective synchronous test (OST) is used to determine which regions of the spine and body structures require adjustment.
We try not to talk too much about low back pain, but as it is the leading cause of disability and the leading cause of years lost to disability worldwide, the conversation around best clinical practice is ongoing. [3]
The aim of this recent study was to investigate the intra- and inter-examiner reliability of the OST used in ABC protocol to assess dysfunction, particularly at the L5 vertebrae. [1] Previous studies have investigated the reliability of other methods of manual therapy at L5. [3-6] The paper cites static identification of the L5 spinous process to be as low as 45% when compared to radiographic analysis. [7]
The research team were also interested in the difference between chiropractors with extensive experience with ABC and those with less experience. To facilitate this, four examiners were recruited; two experienced practitioners and instructors in ABC, and two practitioners certified in ABC at the basic level.
What was found?
A simple summary of the findings of the report is as follows: The results indicated examiners were reliable when using the OST for testing L5.
Intra-examiner reliability varied from slight agreement for one inexperienced examiner, and almost perfect for one expert-level examiner. It is important that tests can be performed consistently by different examiners. Based on statistical analysis, the researchers could support the reliability of OST for testing L5.
While there was variation in the reliability of individual examiners, when results from the inexperienced and expert examiners were combined and compared to each other, no evidence was present to suggest experienced examiners were overall more reliable. Of course, this study only analysed the reliability of four practitioners and a larger group of examiners may reveal the nuances in reliability between those of different levels of experience.
It is encouraging to see the 23 participants included a sample of symptomatic participants. These participants are more representative of those commonly seen in practice. Of course, it should be noted that no test is used in isolation in practice. Multiple tests are utilised as well as general visual observations.
This study follows another piece by Holt et al on the reliable detection of subluxation, and introduces new, technique-specific data to the evidence bank in that it gives a basis for the reliability of tests. [8] As chiropractors, we know the power of adjusting the subluxation. To the rest of the world though, the ability to say it can be reliably diagnosed via tests that have been placed through scientific scrutiny is a significant move forward. Objective support for chiropractic protocols is music to our ears.
References
- Woods B, Thomas N, Stanners M, Holt K. RELIABILITY OF THE OBJECTIVE SYNCHRONOUS TEST AS USED IN ADVANCED BIOSTRUCTURAL CORRECTION TO ASSESS FOR L5 DYSFUNCTION (ROOSTA-L5). Journal of Contemporary Chiropractic. 2023;6(1):1–7.
- Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Annals of Translational Medicine. 2020;8(6):299–9.
- French SD, Green S, Forbes A. Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain. J Manipulative Physiol Ther. 2000;23(4):231-8. DOI: 10.1067/mmt.2000.106101
- Brismée JM, Atwood K, Fain M et al. Interrater reliability of palpation of three-dimensional segmental motion of the lumbar spine. J Manual Manipulative Ther. 2005;13:215-220
- Nolet PS, Yu H, Côté P et al. Reliability and validity of manual palpation for the assessment of patients with low back pain: a systematic and critical review. Chiropr Man Ther. 2021;29: 1-20. DOI: 10.1186/s12998-021-00384-3
- Haneline MT, Young M. A review of intraexaminer and interexaminer reliability of static spinal palpation: a literature synthesis. J Manipulative Physiol Ther. 2009;32,:379-386. DOI: 10.1016/j. Jmpt.2009.04.010
- Merz O, Wolf U, Robert M, Gesing V, Rominger M. Validity of palpation techniques for the identification of the spinous process L5. Man Ther. 2013;18:333-338. DOI: 10.1016/j.math.2012.12.003
- Holt K, Russell D, Cooperstein R, Young M, Sherson M, and Haavik H, (2018), “Interexaminer reliability of a multidimensional battery of tests used to assess for vertebral subluxations,” CJA, Vol 46, Number 1
