Kelly Holt David Russell Robert Cooperstein Morgan Young Matthew Sherson Heidi Haavik


Objective: The purpose of this study was to investigate the interexaminer reliability of assessing for vertebral subluxations using a multidimensional battery of tests and continuous measures analysis approach.

Methods: 70 participants were assessed by 2 blinded examiners. Examiners used a multidimensional battery of tests to assess for vertebral subluxations in 3 regions (cervical, thoracic, lumbar) of the spine, and indicated which segment had the most positive test findings in each spinal region. The distance was measured from the segment to marks that had been placed on the spine. Interexaminer reliability was determined by calculating the median absolute examiner difference in vertebral equivalents (VEs), where a VE is the height of a typical vertebra in each region of the spine. If the median examiner difference was ≤ 1VE, there was definite agreement on the motion segment that had the most subluxation findings. Differences > 1VE but ≤2VE suggested agreement on the same motion segment, and differences >2VE precluded agreement on the same motion segment.

Results: Median absolute examiner differences were 0.5 vertebral equivalents in the lumbar region, 1.0 vertebral equivalent in the cervical and thoracic regions, and 0.6 vertebral equivalents when combined across all regions. In the combined dataset, definite agreement (≤1 vertebral equivalent) occurred 63.3% of the time, possible agreement 19.0% of the time, and definite disagreement 17.6% of the time.

Conclusion:  A multidimensional approach to vertebral subluxation assessment was reliable between examiners for detecting the level of vertebral subluxation in all regions of the spine. Median absolute examiner differences indicated examiners agreed on the motion segment with the most positive vertebral subluxation test findings most of the time. Vertebral subluxation assessment agreement, when analyzed using continuous data, indicates much higher reliability than has previously been associated with assessing agreement using discrete data.