Ave chiropractic tests for the lumbo-pelvic spine reliable and valid? A systematic critical literature review

Objective: To systematically review the peerreviewed literature about the r eliability and validity of chiropractic tests used to determine the need fo r spinal manipulative therapy of the lumbo-pelvic spine, taking into accoun t the quality of the studies. Data Sources: The CHIROLARS database was searched for the years 1976 to 199 5 with the following index terms: "chiropractic tests," "chiropractic adjus ting technique," "motion palpation," "movement palpation," "leg length." "a pplied kinesiology," and "sacrooccipital technique." In addition, a manual search was performed at the libraries of the Nordic Institute of Chiropract ic and Clinical Biomechanics, Odense, Denmark, and the Anglo-European Colle ge of Chiropractic, Bourne mouth, United Kingdom. Study Selection: Studies pertaining to intraexaminer reliability, interexam iner reliability, and/or validity of chiropractic evaluation of the lumbo-p elvic spine were included. Data Extraction: Data quality were assessed independently by the two review ers, with a quality score based on predefined methodologic criteria. Result s of the studies were then evaluated in relation to quality. Data Synthesis: None of the tests studied had been sufficiently evaluated i n relation to reliability and validity. Only tests for palpation for pain h ad consistently acceptable results. Motion palpation of the lumbar spine mi ght be valid but showed poor reliability, whereas motion palpation of the s acroiliac joints seemed to be slightly reliable but was not shown to be val id. Measures of leg-length inequaility seemed to correlate with radiographi c measurements but consensus on method and interpretation is lacking. For t he sacrooccipital technique, some evidence favors the validity of the arm-f ossa test but the rest of the test regimen remains poorly documented. Docum entation of applied kinesiology was not available. Palpation for muscle ten sion, palpation for misalignment, and visual inspection were either undocum ented, unreliable, or not valid. Conclusion: The detection of the manipulative lesion in the lumbo-pelvic sp ine depends on valid and reliable tests. Because such tests have not been e stablished, the presence of the manipulative lesion remains hypothetical. G reat effort is needed to develop, establish, and enforce valid and reliable test procedures.