Inter-examiner reliability of the interpretation of paraspinal thermographic pattern analysis

Abstract

Introduction: A few spinal manipulation techniques use paraspinal surface thermography as an examination tool that informs clinical-decision making; however, inter-examiner reliability of this interpretation has not been reported. The purpose of this study was to report inter-examiner reliability for classifying cervical paraspinal thermographic findings.

Methods: Seventeen doctors of chiropractic self-reporting a minimum of 2 years of experience using thermography classified thermographic scans into categories (full pattern, partial +, partial, partial -, and adaptation). Kappa statistics (k) were calculated to determine inter-examiner reliability.

Results: Overall inter-examiner reliability was fair (k=0.43). There was good agreement for identifying full pattern (k=0.73) and fair agreement for adaptation (k=0.55). Poor agreement was noted in partial categories (k=0.05-0.22).

Conclusion: Inter-examiner reliability demonstrated fair to good agreement for identifying comparable (full pattern) and disparate (adaptation) thermographic findings; agreement was poor for those with moderate similarity (partial). Further research is needed to determine whether thermographic findings should be used in clinical decision-making for spinal manipulation.

Keywords: chiropractic; diagnosis; instrumentation; technique.

Figures

Figure 1.

Thermographic scans. Lines in each column represent temperature readings over the cervical spine. Left column = left cervical spine region, Right column = right cervical spine region, Center column = average of left and right readings. Blue lines represent a static thermographic reading “pattern” obtained over the cervical spine (established by more than 1 reading over a ≥ 24 hour period) and overlaid with a current reading represented by green, red, or orange lines. Categories are based on subjectively comparing a patient’s designated “pattern” (blue lines) with current findings (green, red, or orange lines). Examples of scans representing categories used in this study are displayed: Adaptation = completely dissimilar, Partial (−)= modest similarity, Partial = moderate similarity, Partial (+) mostly similar, Full Pattern = virtually identical.