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Table 4 Evidence Tables

From: The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature

Reliability Studies
Author(s), Year Design,
Sample size (n)
Sample description Measurement method Measure of Reliability
Troyanovich, 2000 [51] Intra-rater and inter-rater reliability; 3 chiropractors familiar with Chiropractic BioPhysics® technique of measurement
n = 36 antero-posterior cervical spine radiographs
Digitized AP cervical spine radiographs without artifacts or other obvious identifying features with the second cervical vertebra through the fourth thoracic vertebra clearly depicted; from patient files of a private chiropractic office 2-dimensional coordinates of 30 points selected by each examiner: R and L narrow-waisted-appearing area of vertebral bodies T1-T4, R and L narrow-waisted-appearing area of the articular pillars of C3-C7, inferolateral aspect of both superior articular facets of C2, most superior portion of spinous process of C2-T4 Intra-rater reliability:
ICC (95% CI), SEM
Tx
Rater 1: 0.99 (0.98–0.99), 1.53
Rater 2: 0.99 (0.99–1.00), 1.03
Rater 3: 1.00 (0.99–1.00), 0.99
Vertebraapex:
Rater 1: 0.96 (0.93–0.98), 0.99
Rater 2: 0.96 (0.92–0.98), 1.10
Rater 3: 0.97 (0.94–0.98), 0.93
Rz:
Rater 1: 0.97 (0.94–0.99), 1.13
Rater 2: 0.94 (0.89–0.97), 1.64
Rater 3: 0.98 (0.95–0.99), 1.06
CDA:
Rater 1: 0.95 (0.91–0.97), 1.52
Rater 2: 0.92 (0.84–0.96), 2.12
Rater 3: 0.94 (0.88–0.97), 1.80
Crossed ICC (95% CI)a [54]
CDA: 0.93 (0.88–0.96)
RzT1-T4:0.96 (0.94–0.98)
Txapex: 0.96 (0.93–0.98)
TxC2-T4: 0.99 (0.99–1.00)
Interrater reliability:
ICC (95% CI)
Tx: 0.99 (0.99–1.00), 1.12
Vertebraapex: 0.98 (0.96–0.99), 0.80
Rz: 0.98 (0.97–0.99), 0.85
CDA: 0.97 (0.95–0.98), 1.22
Crossed ICC (95% CI)a
Cervical Spine
CDA: 0.91 (0.85–0.94)
RzT1-T4: 0.95 (0.90–0.96)
Txapex: 0.93 (0.90–0.96)
TxC2-T4: 0.99 (0.98–0.99)
Troyanovich, 1998 [52] Intra-rater and Inter-rater reliability; 3 chiropractors certified in use of Chiropractic Biophysics® measurement analysis
n = 50, lateral lumbar radiographs
Lateral lumbar radiographs without artifacts or other identifying features; from patient files of a private chiropractic office 1 rater: CBP® standard manual method line drawing of radiographs
2 raters: CBP® standard method of analysis using computerized radiographic digitizer
Measurements derived from 17 selected points used to construct following:
ARA, ARCU, FERG, COBB, S(z), RRAs
Intra-rater reliability
Rater 1
ICC (95% CI); SEM)
T12-L1: 0.54 (0.31–0.71); 2.16
L1-L2: 0.75 (0.60–0.85); 1.82
L2-L3: 0.77 (0.63–0.87); 1.44
L3-L4: 0.85 (0.75–0.91); 1.33
L4-L5: 0.93 (0.88–0.96); 1.39
L5-S1: 0.95 (0.92–0.97); 1.68
ARA: 0.97 (0.94–0.98); 1.74
ARCU: 0.99 (0.99–1.00); 0.74
FERG: 0.94 (0.89–0.96); 1.83
COBB: 0.89 (0.81–0.94); 3.07
Sx: 1.00 (1.00–1.00); 1.07
Rater 2
ICC (95% CI); SEM)
T12-L1: 0.70 (0.53–0.82); 1.46
L1-L2: 0.78 (0.64–0.87); 1.43
L2-L3: 0.61 (0.40–0.76); 2.30
L3-L4: 0.66 (0.47–0.79); 2.20
L4-L5: 0.92 (0.87–0.95); 1.44
L5-S1: 0.96 (0.94–0.98); 1.49
ARA: 0.98 (0.96–0.99); 1.47
ARCU: 0.93 (0.87–0.96); 2.40
FERG: 0.84 (0.73–0.90); 2.85
COBB: 0.88 (0.79–0.93); 3.32
Sx: 0.98 (0.97–0.99); 2.89
Rater 3
ICC (95% CI); SEM)
T12-L1: 0.76 (0.61–0.86); 1.36
L1-L2: 0.77 (0.63–0.86); 1.48
L2-L3: 0.71 (0.54–0.82); 1.73
L3-L4: 0.70 (0.52–0.82); 1.77
L4-L5: 0.91 (0.85–0.95); 1.40
L5-S1: 0.97 (0.95–0.98); 1.40
ARA: 0.96 (0.93–0.98); 1.88
ARCU: 0.87 (0.78–0.92); 3.40
FERG: 0.83 (0.73–0.90); 2.77
COBB: 0.95 (0.92–0.97); 1.99
Sx: 0.99 (0.98–0.99); 2.14
Inter-rater reliability
Rater 1–2 (manual-computer)
ICC (95% CI); SEM
ARA L1–5: 0.98 (0.96,0.99); 1.40
ARCU: 0.97 (0.95–0.98); 1.48
FERG: 0.88 (0.80–0.93); 2.42
COBB: 0.88 (0.79–0.93); 3.22
S(z): 0.99 (0.99–1.00); 1.70
RRAs:
T12-L1: 0.68 (0.50–0.81); 1.49
L1-L2: 0.79 (0.65–0.87); 1.45
L2-L3: 0.77 (0.63–0.86); 1.49
L3-L4: 0.83 (0.71–0.90); 1.40
L4-L5: 0.90 (0.84–0.94); 1.56
L5-S1: 0.97 (0.94–9.98); 1.42
Rater 1–3 (manual-computer)
ICC (95% CI); SEM
ARA L1–5: 0.96 (0.93,0.98); 1.94
ARCU: 0.85 (0.76,0.91); 3.32
FERG: 0.79 (0.65,0.87); 3.25
COBB: 0.83 (0.72,0.90); 3.78
S(z): 1.00 (0.99,1.00); 1.36
RRAs:
T12-L1: 0.66 (0.47,0.79); 1.59
L1-L2: 0.74 (0.58,0.84); 1.62
L2-L3: 0.76 (0.61,0.85); 1.43
L3-L4: 0.78 (0.65,0.87); 1.46
L4-L5: 0.88 (0.81,0.93); 1.64
L5-S1: 0.80 (0.67,0.88); 3.61
Rater 2–3 (computer-computer) ICC (95% CI); SEM
ARA L1–5: 0.96 (0.94,0.98); 1.76
ARCU: 0.83 (0.73,0.90); 3.60
FERG: 0.84 (0.74,0.91); 2.63
COBB: 0.92 (0.86,0.95); 2.67
S(z): 0.99 (0.98,0.99); 2.16
RRAs:
T12-L1: 0.63 (0.43,0.77); 1.57
L1-L2: 0.72 (0.55,0.83); 1.53
L2-L3: 0.72 (0.55,0.83); 1.67
L3-L4: 0.72 (0.55,0.83); 1.70
L4-L5: 0.90 (0.84,0.94); 3.50
L5-S1: 0.81 (0.70,0.89); 3.50
Troyanovich, 1995 [53] Intra-rater and inter-rater reliability; 3 chiropractors certified in Chiropractic BioPhysics® method of measurement
n = 35 lateral lumbar radiographs
Lateral lumbar radiographs without artifacts or other obvious identifying features selected from patient files of a private, primary-care chiropractic clinic Arcuate line, Ferguson’s sacral-base line, vertical axis line, L1 and L5 stress lines and L1 and L5 posterior body lines, arcuate angle, relative rotation angle, absolute rotation angle, linear anterior or posterior displacement of the lower thoracic spine Intra-rater reliability:
ICC (95% CI), SEM
L1-L5
Rater 1: 0.98 (0.92–0.99), 1.48
Rater 2: 0.98 (0.95–0.99), 1.53
Rater 3: 0.98 (0.96–0.99), 1.58
Sz
Rater 1: 0.99 (0.99–1.00), 1.86
Rater 2: 0.97 (0.94–0.98), 4.26
Rater 3: 0.99 (0.98–1.00), 1.97
AA
Rater 1: 0.40 (0.02–0.65), 5.03
Rater 2: 0.81 (0.65–0.90), 2.93
Rater 3: 0.71 (0.49–0.85), 3.53
FERG
Rater 1: 0.97 (0.94–0.98), 1.41
Rater 2: 0.97 (0.94–0.98), 1.45
Rater 3: 0.91 (0.82, 0.95), 2.12
L1-L2
Rater 1: 0.87 (0.76, 0.93), 1.77
Rater 2: 0.84 (0.71–0.92), 1.84
Rater 3: 0.94 (0.88–0.97), 1.3
L2-L3
Rater 1: 0.85 (0.72–0.92), 1.54
Rater 2: 0.81 (0.66–0.90), 1.31
Rater 3: 0.80 (0.64–0.89), 1.79
L3-L4
Rater 1: 0.89 (0.79–0.94), 1.09
Rater 2: 0.81 (0.66–0.90), 1.52
Rater 3: 0.78 (0.60–0.88), 1.67
L4-L5
Rater 1: 0.89 (0.80–0.94), 1.49
Rater 2: 0.92 (0.85–0.96), 1.17
Rater 3: 0.87 (0.76–0.93), 1.69
Inter-rater reliability:
ICC (95%), SEM
L1-L5: 0.98 (0.96–0.99), 1.66
Sz: 0.98 (0.97–0.99), 3.20
AA: 0.66 (0.48, 0.79), 3.51
FERG: 0.95 (0.91–0.97), 1.73
L1-L2: 0.88 (0.81–0.94), 1.63
L2-L3: 0.84 (0.74–0.91), 1.43
L3-L4: 0.91 (0.85, 0.95), 0.97
L4-L5: 0.93 (0.89–0.96), 1.14
Haas, 1990 [50] Inter-rater reliability; 2 radiology residents
n = 58
PA, PA right and left lateral bending lumbar radiographs of volunteer students in a chiropractic institution Vertebral body rotation and vertebral body tilting (intersegmental tilt measured as neutral, L or R lateral bending), radiographs categorized into:
I. Ipsilateral tilt with contralateral rotation
II. Ipsilateral tilt with ipsilateral rotation
III. Contralateral tilt with contralateral rotation
IV. Contralateral tilt with ipsilateral rotation
L Lateral Bending Radiograph
Global Motion: K (SE)
V = overall agreement
Rater 1 and 2
I. 0.63 (0.17)
II. 0.60 (0.17)
III. 0.54 (0.17)
IV. 0.71 (0.17)
V. 0.60 (0.10)
R Lateral Bending Radiograph
Global Motion: K (SE)
V = overall agreement
Rater 1 and 2
I. 0.64 (0.17)
II. 0.61 (0.16)
III. 0.09 (0.17)
IV. 0.72 (0.16)
V. 0.58 (0.10)
McGregor, 1995 [46] Intrarater and interrater reliability; 2 chiropractic radiology residents
n = 506
Neutral lateral, flexion lateral and extension lateral radiographs Measure intersegmental motion excursion of each vertebra (% of sagittal body diameter) Intrarater reliability: Generalizability coefficients
C2 Flexion: 0.47
C2 Extension: 0.53
C3 Flexion: 0.66
C3 Extension: 0.68
C4 Flexion: 0.67
C4 Extension: 0.74
C5 Flexion: 0.56
C5 Extension: 0.74
C6 Flexion: 0.65
C6 Extension: 0.59
C7 Flexion: 0.49
C7 Extension 0.07
Interrater reliability: Generalizability coefficients
C2 Flexion: 0.36–0.43
C2 Extension: 0.35–0.43
C3 Flexion: 0.60
C3 Extension: 0.67
C4 Flexion: 0.63
C4 Extension: 0.70–0.77
C5 Flexion: 0.55–0.56
C5 Extension: 0.70–0.71
C6 Flexion: 0.53–0.58
C6 Extension: 0.50–0.53
C7 Flexion: 0.02
C7 Extension 0.00
Troyanovich, 1999 [55] Intra-rater and inter-rater reliability; 3 chiropractors familiar with Chiropractic BioPhysics® technique method of measurement
n = 37 anterioposterior lumbopelvic radiographs
Digitized AP lumbopelvic radiographs without artifacts or other obvious identifying features 2-dimensional coordinates of 33 points selected by each examiner: R and L superior and inferior corners of each vertebral body from T12 through L5, the most superior portion of the spinous processes of T12 through L5 and S2, and the R and L superolateral aspects of the sacral base
Computer calculated lines of lateral displacement from true vertical, magnitude of angle of intersection of two lines (LDA), angle of intersection of inferior line with sacral base line (LS angle), horizontal line across sacral base (HB line), true vertical axis line from the spinous process of S2 cephalically and parallel to the lateral edge of the x-ray film (VAL)
Intra-rater reliability
ICC (95% CI), SEM
HB angle
Rater 1: 0.72 (0.52–0.84), 1.62
Rater 2: 0.75 (0.57–0.87), 1.78
Rater 3: 0.94 (0.89–0.97), 0.67
LD angle
Rater 1: 0.91 (0.83–0.95), 1.22
Rater 2: 0.90 (0.82–0.95), 1.33
Rater 3: 0.96 (0.92–0.98), 0.87
LS angle
Rater 1: 0.84 (0.72–0.92), 2.04
Rater 2: 0.88 (0.77–0.93), 2.07
Rater 3: 0.96 (0.93–0.98), 0.93
TxT12
Rater 1: 0.97 (0.94–0.98), 1.53
Rater 2: 0.95 (0.91–0.97), 1.95
Rater 3: 0.97 (0.95–0.99), 1.40
Crossed ICC (95% CI)a
HB angle: 0.78 (0.67–0.86)
LD angle: 0.92 (0.87–0.95)
LS angle: 0.88 (0.81–0.93)
TxT12-S1: 0.96 (0.94–0.98)
Inter-rater reliability
ICC (95% CI), SEM
HB angle: 0.71 (0.56–0.82), 1.62
LD angle: 0.97 (0.94–0.98), 0.75
LS angle: 0.83 (0.73–0.90), 2.13
TxT12: 0.95 (0.91–0.97), 2.01
Crossed ICC (95% CI)a [54]
HB angle: 0.61 (0.49–0.73)
LD angle: 0.89 (0.83–0.94)
LS angle: 0.76 (0.66–0.85)
TxT12-S1: 0.92 (0.88–0.95)
Jackson, 1993 [56] Intrarater and interrater reliability; 3 chiropractors certified in use of Chiropractic BioPhysics®
n = 65
Lateral cervical films from patient files of a primary care private chiropractic clinic Standard CBP® measurement protocols: Atlas plane line, Ruth Jackson’s stress lines, vertical axis line and C2 through C7 posterior body lines; relative rotation angle measurements, ARA Intra-rater reliability
Not reported due to inadequate statistics used to compute reliability.
Inter-rater reliability
Bartko’s ICC; SEM
Atlas plane line:
0.93; 1°
ARA:
0.96; 1.20°
Anterior head translation:
0.80; 1.23 mm
Intersegmental angle C2–3:
0.72; 0.57°
Intersegmental angle C3–4:
0.79; 0.54°
Intersegmental angle C4–5:
0.86; 1.04°
Intersegmental angle C5–6:
0.79; 0.66°
Intersegmental angle C6–7:
0.74; 0.65°
  1. AA arcuate angle; ARA absolute rotation angle; ARCU arcuate angle measurement; CBP® Chiropractic Biophysics®; CDA cervicodorsal angle; COBB Cobb angle measurement; FERG Ferguson’s angle measurement; HB angle angle of sacral base compared to horizontal; HB line horizontal line intersection line drawn across the sacral base; L left; LD angle lumbo-dorsal angle, angle of best fit line form lumbar apex to L5 compared to the sacral base; LS angle lumbosacral angle, angle of best fit line from lumbar apex to L5 compared to the sacral base; R right; RRA intersegmental measurements; Ry segmental axial rotation angles; Rz magnitude of the angle of intersection between vertical axis line and lower most line; SEM standard error of measurement; S(z) translation measurement of lower thoracic spine to S1; Tx perpendicular distance from vertical axis line to the center of the vertebral body of C2; TxT12 lateral translation distance of T12 compared to 9S2; VAL vertical axis line; vertebraapex: linear distance from center of vertebra most displaced from line connecting the centers of C2 and T4
  2. a Harrison 2002 [54] calculated crossed ICCs from two individual studies, these calculations are presented with the original articles