PTJ
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

PHYS THER
Vol. 80, No. 5, May 2000, pp. 528-529
This Article
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Rapid Responses are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cibulka, M. T
Right arrow Articles by Riddle, D. L
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cibulka, M. T
Right arrow Articles by Riddle, D. L

Letters and Responses

Pelvic Asymmetry Reliability


To the Editor:

We would like to comment on the research report by Freburger and Riddle entitled "Measurement of Sacroiliac Joint Dysfunction: A Multicenter Intertester Reliability Study" (December 1999).

The authors used a multicenter approach to examine the reliability of measurements obtained with an infrequently used method for assessing pelvic asymmetry (use of handheld calipers) during standing. First, we were unsure whether any of the examiners were trained at all with this method. This was not apparent in the article, which stated that "therapists were asked to practice the procedure on each other and to begin data collection when the therapists believed [our emphasis] they were prepared to use the procedure on patients." We did not quite understand what "believe" meant. We agree with Hayes,1 who suggests that with any type of testing that involves some complexity (such as using calipers) or where patients will be examined by many practitioners, time should be spent to standardize procedures and receive training as a group until a criterion level of reliability has been reached. From personal experience, we know that pelvic calipers are not the easiest device to master in a busy outpatient clinic.

Based on the evidence presented by Freburger and Riddle, we agree that pelvic calipers probably should not be used to assess anatomical asymmetry in this sort of clinical setting. However, we do not believe that the authors convinced us, with this study, that all tests that have been called sacroiliac joint symmetry tests are not useful. Moreover, we do not believe that this premise was tested in the study.

Michael T Cibulka, PT, MHS, OCS

Jefferson County Rehabilitation & Sports Clinic
430 S Truman Blvd
Crystal City, MO 63019

Kady Aslin, SPT

DPT Student
Creighton University
Omaha, NE 68178

References

  1. Hayes KW. Making tests with low reliability work for you. Orthopedic Physical Therapy Practice.1999; 11(1):28–29.
 

Author Response:


Cibulka and Aslin's letter raises 2 concerns about our study. One of their concerns has to do with the training of our examiners. As we stated in our research report, therapists who participated in the study were given written instructions on the measurement procedure, and the primary author demonstrated the procedure. What we failed to include in the description of our training method was that the therapists practiced the measurement procedure in the presence of the primary author, who offered feedback and answered questions. The actual amount of time the primary author spent with each clinic varied, depending on the size of the clinic, with an average of approximately 60 minutes. At the completion of the primary author's visit, the examiners were told to practice the technique until they believed they were prepared to use the procedure on patients (ie, felt comfortable with the procedure).

We chose our training method over a more standardized approach because we wanted to increase the external validity of the study. Ideally, therapists should be able to read the operational definition of a measurement procedure and replicate the procedure in their own clinics. We believed that if we found acceptable reliability, other therapists replicating the methods could theoretically expect similar amounts of measurement error. Had we spent more time standardizing the procedure, as Cibulka and Aslin suggest, we would have limited the generalizability of our study (ie, other therapists would likely not be able to replicate the findings of our study without additional training).

Cibulka and Aslin reference the work of Hayes1 to argue that clinicians who work with the same patients should undergo standardized training on a procedure to increase intertester reliability. We could not agree more. However, not all measures require extended training sessions to achieve acceptable intertester reliability.2,3 Rothstein et al,2 for example, did not specially train the therapists who participated in their study, and they reported high intertester reliability for goniometric measures of knee and elbow joint passive range of motion. Likewise, Wilson et al3 did not specially train therapists in their study and reported moderate intertester reliability for a low back pain classification system that involved the assessment of the patient's symptoms during different movement tests. Furthermore, the therapists in their study had been practicing for only 3 to 15 months. We believed, going into our study, that the measurement procedure was reasonably simple and did not require extended training. The feedback from the therapists who participated in our study supported this belief.

Cibulka and Aslin's second concern has to do with the premise of our study. We agree that the premise of our study was not to look at the usefulness of what are called sacroiliac joint symmetry tests. Our study only provides additional evidence to suggest that current techniques for assessing sacroiliac joint symmetry are not likely to be useful for detecting innominate asymmetry. We took an evidence-based approach in making our conclusions and suggestions. Although the research is limited, the radiographic and reliability studies cited in our research report generally do not support the use of tests designed to assess sacroiliac joint symmetry.

Janet K Freburger, PT, PhD

Assistant Professor
Division of Physical Therapy
The University of North Carolina at Chapel Hill
Chapel Hill, NC

Daniel L Riddle, PT, PhD

Associate Professor
Department of Physical Therapy
Virginia Commonwealth University
Richmond, Va

References

  1. Hayes KW. Making tests with low reliability work for you. Orthopedic Physical Therapy Practice.1999; 11(1):28–29.
  2. Rothstein JM, Miller PJ, Roettger RF. Goniometric reliability in a clinical setting: elbow and knee measurements. Phys Ther.1983; 63:1611–1615.[Abstract/Free Full Text]
  3. Wilson L, Hall H, McIntosh G, Melles T. Intertester reliability of a low back pain classification system. Spine.1999; 24:248–254.[ISI][Medline]




This Article
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Rapid Responses are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cibulka, M. T
Right arrow Articles by Riddle, D. L
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cibulka, M. T
Right arrow Articles by Riddle, D. L

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2000 by the American Physical Therapy Association.