Locating the Seventh Cervical Spinous Process: Development and Validation of a Multivariate Model Using Palpation and Personal Information

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• 作者：Ana Paula A. Ferreira ; MSc^a ; Luciana C. Pó ; voa ; MSc^a ; José ; F.C. Zanier ; DSc^b ; Arthur S. Ferreira ; DSc^a ; ^{arthurde@unisuamdoc.com.br}
• 关键词：Cervical Vertebrae ; Palpation ; Physical Examination ; Diagnostic Errors ; Physical Therapy Specialty ; Rehabilitation
• 刊名：Journal of Manipulative and Physiological Therapeutics
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：40
• 期：2
• 页码：89-97
• 全文大小：548 K
• 卷排序：40

文摘

The aim of this study was to develop and validate a multivariate prediction model, guided by palpation and personal information, for locating the seventh cervical spinous process (C7SP).MethodsA single-blinded, cross-sectional study at a primary to tertiary health care center was conducted for model development and temporal validation. One-hundred sixty participants were prospectively included for model development (n = 80) and time-split validation stages (n = 80). The C7SP was located using the thorax-rib static method (TRSM). Participants underwent chest radiography for assessment of the inner body structure located with TRSM and using radio-opaque markers placed over the skin. Age, sex, height, body mass, body mass index, and vertex-marker distance (DV-M) were used to predict the distance from the C7SP to the vertex (DV-C7). Multivariate linear regression modeling, limits of agreement plot, histogram of residues, receiver operating characteristic curves, and confusion tables were analyzed.ResultsThe multivariate linear prediction model for DV-C7 (in centimeters) was DV-C7 = 0.986DV-M + 0.018(mass) + 0.014(age) – 1.008. Receiver operating characteristic curves had better discrimination of DV-C7 (area under the curve = 0.661; 95% confidence interval = 0.541-0.782; P = .015) than DV-M (area under the curve = 0.480; 95% confidence interval = 0.345-0.614; P = .761), with respective cutoff points at 23.40 cm (sensitivity = 41%, specificity = 63%) and 24.75 cm (sensitivity = 69%, specificity = 52%). The C7SP was correctly located more often when using predicted DV-C7 in the validation sample than when using the TRSM in the development sample: n = 53 (66%) vs n = 32 (40%), P < .001.ConclusionsBetter accuracy was obtained when locating the C7SP by use of a multivariate model that incorporates palpation and personal information.