Influence of Transverse Process Landmark Localization on Palpation Accuracy of Lumbar Spine Models

• Published in: Journal of Osteopathic Medicine (Online) 2018-03, Vol.118 (3), p.151-158
• Main Authors: Snider, Eric J., Pamperin, Kenneth, Pazdernik, Vanessa, Degenhardt, Brian F.
• Format: Article
• Language: English
• Subjects: Accuracy; Asymmetry; Clinical Competence; Cohort Studies; Curriculum; Generalized linear models; Humans; Localization; lumbar spine; Lumbar Vertebrae; Medical students; Models, Anatomic; Osteopathic Medicine - education; Palpation; Random variables; Reproducibility of Results; transverse process
• ISSN: 2702-3648; 2702-3648; 1945-1997
• DOI: 10.7556/jaoa.2018.034

Accurate determination of transverse process displacement in the horizontal plane requires accurate transverse process landmark localization followed by accurate discrimination of asymmetry by the examiner's palpating digits. To determine whether the accurate localization of transverse process landmarks influences overall accuracy of asymmetry determination in third-year osteopathic medical students evaluating covered lumbar spine models. A class of third-year osteopathic medical students was split into 2 groups and asked to determine whether the right transverse processes of covered lumbar spine models were anterior or posterior relative to the left transverse process. The marked model group (group A) was provided covered models with black dots on the fabric covers over the transverse process landmarks, while the covered models given to the students in the unmarked model group (group B) had no markings. Both groups were asked to assess asymmetry differences from L1 to L5 on 2 models. Landmarks were randomized for asymmetry (ranging from 2 mm to 6 mm) and direction (anterior or posterior on the right side). The number of correct responses was modeled as a binomial random variable in a generalized linear model to compare the effects of marked vs unmarked models on accuracy of palpation. The predicted probability of correctly determining the direction of the asymmetry and 95% CIs were calculated. The probability of correctly identifying the direction of asymmetry was 0.89 (95% CI, 0.87-0.91) for group A and 0.74 (95% CI, 0.71-0.78) for group B, a 15 percentage point difference (OR, 1.2; 95% CI, 1.1-1.3; P