REPRODUCIBILITY OF EXAMINER PERFORMANCE FOR MUSCLE AND JOINT PALPATION IN THE TEMPOROMANDIBULAR SYSTEM FOLLOWING TRAINING AND CALIBRATION

The purpose of this investigation was to assess examiner ability to co nsistently perform specific tasks related to muscle and joint palpatio n. Four trained and calibrated examiners were asked 1) to deliver inde x finger pressures within a high (1.5-2.1 kg) and low (0.5-1.1 kg) tar get pressure range and 2) to precisely locate one joint palpation and four muscle sites. After passing a calibration test, the performance o f the examiners was monitored during the course of a replicability stu dy assessing the consistency of clinical findings during repeated exam s for TM disorders. (1) Index finger pressure was regularly tested ove r a 3-month period with a hand held pressure algometer, and the readin g of each trial was recorded. Data analysis showed a high proportion o f trials within the pressure range (overall 89.5%). Examiner performan ce across target range of pressures was statistically different for su ccess rate and mean pressure delivered. The differences in the mean fi nger pressure delivered by each examiner (intraexaminer variation) was low and varied from 0.12 to 0.22 kg/cm2 for the desired range of pres sures. (2) Paired examiners were asked to independently and sequential ly mark palpation sites over the forehead, superficial and deep masset er, anterior temporalis, and lateral capsule of the temporomandibular joint. Replicability of site locations was assessed by measuring, with a boley gauge, the distance between sites selected by the paired exam iners. Except for the superficial masseter and the anterior temporalis , the paired examiners selected palpation sites within a distance of 7 mm more than 85% of the time. The mean distance between guessed palpa tion sites was the lowest for the forehead (3.6 mm; sd = 3.0) and the highest for the anterior temporalis (5.9 mm; sd = 3.5). Overall, this study clearly shows the. ability of trained examiners to consistently perform technical tasks critical to the replicability of manual palpat ion procedures.