Reliability and validity of manual palpation for the assessment of patients with low back pain: a systematic and critical review

Review written by Dr Jarod Hall info

Key Points

  1. Static or motion manual palpation of the low back is commonly used to assess pain location and reproduction in low back pain (LBP) patients.
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BACKGROUND & OBJECTIVE

Low back pain (LBP) is the leading cause of years lived with disability and is the sixth leading cause of disability adjusted life years globally and it is associated with poor health-related quality of life and has a substantial economic burden to society (1,2).

The clinical assessment of low back pain involves completing a physical examination, of which manual palpation is a common tool. This often includes static and dynamic palpation of soft tissue or joints and aims to identify painful structures and biomechanical dysfunction of the spine; however, the clinical utility of these tests is controversial.

Previous systematic reviews have investigated the reliability and validity of manual palpation for the assessment of patients with LBP (3-5). According to these reviews, the inter-rater reliability of static joint and soft-tissue palpation to locate pain is poor (kappa (k) ≤ 0.40), and the inter-rater reliability of static palpation for soft tissue changes (tension) is inconsistent.

Therefore, the purpose of this systematic review was to determine the reliability and validity of manual palpation used to assess adult patients with LBP.

Low back pain is the leading cause of years lived with disability.
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Caution should be exercised when utilizing information found from these types of examination procedures to diagnose pathology and guide treatment.

METHODS

The authors systematically searched the following electronic databases: MEDLINE, CINAHL, PubMed, Cochrane Central Register of Controlled Trials, and SPORTDiscus. Search terms consisted of subject headings specific to each database (MeSH in MEDLINE) and free text words relevant to LBP, diagnosis,

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