Evaluating for a Correlation Between Osteopathic Examination and Ultrasonography on Thoracic Spine Asymmetry
Condition: Osteopathic Manipulative Treatment; Ultrasonography
Study type: Observational

Summary: 
      Context: Thoracic spine is a common area of focus in osteopathic manipulative medicine (OMM)
      for a variety of conditions. Thoracic spine somatic dysfunction diagnosis is achieved by
      palpating for asymmetry at the tips of the transverse processes. Previous studies reveal
      that, instead of following the rule of threes, the transverse processes of a given thoracic
      vertebra generally align with the spinous process of the vertebra above. Ultrasonography has
      been widely used as a diagnostic tool to monitor musculoskeletal conditions. Ultrasound has
      the advantage of absence of radiation, and has shown comparable results to gold standard
      modalities like MRI in some areas of the spine. In the case of thoracic somatic dysfunction,
      ultrasound can be used to determine the location of each vertebral transverse process and its
      relationship with the spinous process. Previous studies have investigated the correlation
      between osteopathic manipulative medicine and ultrasonography of the cervical, lumbar, and
      sacral regions. However, no study has yet compared osteopathic structural examination with
      ultrasonographic examination of the thoracic vertebral region.

      Objective: To determine whether there is a dependable correlation of osteopathic palpatory
      findings of the thoracic transverse processes with the measurements of ultrasonography.

      Methods: Subjects were student volunteers recruited from the Midwestern University - Glendale
      campus. A non-toxic, non-permanent marker was used to mark bony landmarks on the skin to be
      used by the osteopathic examiners. Two osteopathic physicians (OMM1, OMM2) separately
      performed structural exams by palpating T2-T5 transverse processes to determine vertebral
      rotation. Two trained sonographers (US1, US2) separately scanned and measured the distance
      from the tip of the spinous process to the adjacent transverse processes of the vertebral
      segment below. Demographic variables were summarized with mean and standard deviation.
      Interexaminer reliability was assessed with percent agreement, Cohen's Kappa, and Fleiss'
      Kappa. Recruitment and protocols were approved by the MWU Institutional Review Board.
    


Intervention name(s): Ultrasonography vs Osteopathic manipulative medicine structural exam
Intervention type(s): Diagnostic Test
Intervention description(s): Structural examination of the thoracic spine using ultrasound and osteopathic palpatory examination on skin.
Observational model: Other
Time perspective: Other
Sampling method: Non-Probability Sample
Study population: 
        Subjects are Midwestern University students who were recruited via email announcements,
        with responses recorded via secure Google Form that was accessible only to the Midwestern
        University network.

        The overall demographics of participants showed 31 (47.0%) males and 35 (53.0%) females.
        Race and ethnicity were not collected for the purpose of this study as it was not a
        variable being evaluated or investigated. The subjects' age range is 22-35 years of age,
        with the mean age as 26.61 (SD = 3.1) for males and 25.71 (SD = 2.7) for females. The BMI
        range is 15.9 - 36.9kg/m2, with the mean BMI as 24.13 (SD = 4.2) overall, 25.46 (SD = 3.5)
        for males and 22.95 (SD = 4.5) for females.