Doctor of Physical Therapy (DPT)
Objective: To investigate the reliability of the Thoracic Percussion Test (TPT), which is a quick screening tool used by manual therapists to assess hypomobility in the thoracic spine. Participants: 36 healthy subjects (18-60 years old), with or without back pain, and 10 therapists participated in the study. Six of the therapists with less than 5 years clinical experience were considered “novice” and 4 with at least 20 years experience were considered “expert” therapists. Methods: All participants were divided into a morning and an afternoon group. Both groups consisted of 18 subjects and a mix of novice and expert therapists. All therapists were given a 30-minute instructional PowerPoint on the TPT upon arrival. The therapists and subjects were randomized and therapists were instructed to tap along each subject’s paraspinal musculature and asked to indicate the most significant level of the thoracic spine that they felt would require treatment first. The therapists and subjects were randomized once again and the therapists were asked to repeat the same protocol. Data Analysis: Descriptive statistics, including estimates of central tendency and variability, were calculated to describe the sample of subjects and therapists. Intra-rater reliability of the TPT was estimated for judgments of the most significant spinal segment. We calculated agreement within each rater through linear weighted Kappa coefficients with 95% confidence intervals. Negative Kappa values would indicate agreement less than chance. We determined a priori that if intra-rater reliability was only fair (between 0.21 and 0.40), there would be no need to test for inter-rater reliability. Results: The mean linear-weighted Kappa statistic for judgments of the most significant spinal segment for all therapists was 0.21 ± 0.190 and ranged between -0.21 and 0.40. These results indicate that agreement within therapists was between slight and fair at best. Because of the poor intra-rater reliability, we did not examine inter-rater reliability in this study. Discussion: Our findings suggest that the TPT has poor intra-rater reliability and concur with those of a previous reliability study performed by Ghoukassian et al 2001, which found the TPT to have poor reliability. Our study expanded the results to include male and female spines of varying ages, in addition to including novice and experienced clinicians, and yet we found the TPT had poor reliability. Conclusions: The intra-rater reliability for the TPT was not strong enough to justify its continued use as a screening or assessment tool in evidence based practice until further research is performed.
Donaldson, Casey; Veloz, Rey; and Waters, Kaylee, "The Reliability of the Thoracic Percussion Test" (2017). UNLV Theses, Dissertations, Professional Papers, and Capstones. 2926.