Kmita and Lucas, 200831 | Double-blind assessment performed twice | 5 symptomatic and 4 asymptomatic patients; 4 examiners (2 clinicians, 2 students) | PSIS, 0.04/0.13 SS, -0.40/0.283 ILA-S/I, -0.01/0.058 ILA-A/P, -0.03/0.095 ASIS, 0.13/0.403 | 6 (100) 1, 1, 1, 1, 1, 1 | Alternatives to static asymmetry assessment are recommended for assessment of low back pain and/or pelvic dysfunction. |
Holmgren and Waling, 200832 | Independent examination performed once; only interexaminer reliability was assessed | 25 symptomatic patients; 2 examiners (experienced clinicians) | L5 transverse processes, 0.17 SS, 0.11 ILA-A/P, 0.11 | 3.5 (58) 0, 1, 1, 0, 0.5, 1 | Interexaminer reliability observed was only slightly better than expected by chance; low interexaminer reliability was attributed to differences in palpation technique. |
Tong et al, 200633 | 2rounds of evaluation; 3methods for analyzing results; only interexaminer reliability was assessed | 24 symptomatic patients; 2 examiners (training level unknown) | SS‡ in trunk flexion, 0.37 SS‡ in trunk extension, 0.05 ASIS, 0.15 | 3.5 (58) 0, 1, 1, 0, 0.5, 1 | Maximum interexaminer reliability occurs when the most reliable test is used to evaluate SIJ dysfunction; this method is suggested in clinical decision making. |
Fryer et al, 200534 | Trained group of examiners had 2 1-h training sessions; each landmark examined 3 times | 10 asymptomatic patients; 2 groups of 5 examiners (trained and untrained fifth-year students) | Untrained: PSIS, 0.15/0.49 ILA-S/I, -0.01/0.03 ILA-A/P, -0.01/0.2 ASIS, -0.01/0.19 Trained: PSIS, 0.08/0.54 ILA-S/I, 0.04/0.2 ILA-A/P, 0.040.07 ASIS, 0.24/0.65 | 6 (100) 1, 1, 1, 1, 1, 1 | Osteopathic physicians should reconsider these tests in evaluation of the SIJ. Training inconclusively improved assessment of anatomic landmark asymmetry; an improved understanding of these evaluation procedures is recommended. |
Degenhardt et al, 200535 | 3 phases of experiment: phase 1, multiple tests; phase 2, consensus training over 4 mo for most reliable tests from phase 1; and phase 3, examinations with trained assessments | 42 symptomatic patients evaluated before training, 77 after training; 3 examiners (trained in manual medicine) | L1-L4 transverse processes,§ 0.17 (untrained) and 0.34 (trained) | 5 (83) 0, 1, 1, 1, 1, 1 | Consensus training can significantly improve interexaminer agreement for palpatory examinations. |
Spring et al, 200136 | Fifth-year students; 3-part positional screen in neutral, hyperflexed, and extended positions; 1 h of training before examination; total of 3 examinations | 10 asymptomatic patients; 10 examiners (fifth-year students | L4, 0.04/0.037 | 6 (100) 1, 1, 1, 1, 1, 1 | No significant agreement above chance was found for inter- or intraexaminer reliability. Poor reliability may be attributed to anatomy of lumbar spine; caution is suggested in using static asymmetry for lumbar spine assessment. |
O'Haire and Gibbons, 200037 | 4 assessments per examiner; 1-h training session to standardize methods | 10 asymptomatic patients; 10 examiners (fifth-year students) | PSIS, 0.04/0.326 SS, 0.07/0.24 ILA-S/I, 0.08/0.211 | 6 (100) 1, 1, 1, 1, 1, 1 | Further studies are needed to better understand the low reliability of anatomic landmark assessment of the SIJ. |
Paydar et al, 199438∥ | Standing and sitting landmarks assessed; 2 evaluations with second 3 h after the first | 32 asymptomatic patients; 2 examiners (student interns with ≥1 year of clinical experience | PSIS, 0.150/0.248 | 3 (50) 1, 1, 0, 0, 0, 1 | Palpatory findings should not be the primary factor in clinical decision making; the patient's response to the treatment is probably the only indication that the diagnosis was correct. |
Potter and Rothstein, 198539∥ | Clinicians; 13 common tests assessed | 17 symptomatic patients; 8 examiners (clinicians) | Standing PSIS,§ 35.29% agreement sitting PSIS,§ 35.29% agreement standing ASIS,§ 37.50% agreement; χ2 value calculated for goodness of fit with 90% and 70% agreement expected | 2 (33) 0, 1, 1,0, 0, 0 | The poor reliability observed suggests that new operational definitions for SIJ evaluation are needed; given that clinicians in the same profession evaluated the patients, this study raises issues of continuity of care. |