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Table 1 OSPE Checklist

From: Peyton’s four-step approach for teaching complex spinal manipulation techniques – a prospective randomized trial

Name: Rater #  
Student ID:   
Exam Date:   
Item 1. Cervical Spinal Correct Incorrect
  a) Three-Step-Diagnosis   
1 Examiner faces the patient   
2 Locates point of irritation (IP) (one finger’s breadth lateral of the spinous process)   
3 Consults the patient for pain   
  Segmental hypomobility   
4 Palpates the spinous processes C4-C6   
5 Checks cervical rotation   
6 Checks cervical flexion   
  Response of the IP to movement   
7 Palpates IP   
8 Checks cervical rotation   
9 Consults the patient for increase/decrease in pain intensity and change in consistency of the IP during movement   
  b) Rotation-traction-technique   
  Positioning of the patient   
10 Upright position, adequate seat height   
11 Examiner stands beside the patient   
  Hand placement   
12 Proximal phalanx of the thumb level to zygoma   
13 Forefinger yoke   
14 Other hand immobilizes inferior border of vertebral arch   
15 15°-degree tilt of the head to farside of the examiner   
16 15°-degree rotation to uninvolved side   
17 Builds up pre-tension (traction/rotation)   
  Test traction   
18 Further rotation of the neck   
19 Consults the patient for increase in pain intensity, other symptoms, dizziness   
20 Returns to pre-tension   
  Manipulation   
21 Rotational impulse to uninvolved side   
22 Manipulation in expiration   
  2. Thoracic spine Correct Incorrect
  a) Three-Step-Diagnosis   
23 Patient is in prone position   
24 Locates point of irritation (IP) (one finger’s breadth lateral of the spinous process)   
25 Consults the patient for pain   
  Segmental hypomobility   
26 Palpates the spinous processes (three adjacent vertebrae)   
27 Checks rotation (lifts arm)   
28 Checks flexion   
  Response of the IP to movement   
29 Palpates IP   
30 Checks rotation (lifts arm)   
31 Consults the patient for increase/decrease in pain intensity and change in consistency of the IP during movement   
  b) Cross-hand-technique   
  Positioning of the patient   
32 Patient is in prone position   
33 Positions him/herself on rotation-sensitive side   
  Hand placement   
34 Places hypothenar eminence of left hand over posterior transverse process of dysfunctional segment   
35 Fingers pointing cranially   
36 Places hypothenar eminence of right hand over opposite side transverse process approximately one segment below dysfunctional segment   
37 Fingers pointing laterally   
38 Builds up pre-tension   
  Test traction   
39 Puts more pressure on transverse process   
40 Consults the patient for increase in pain intensity, other symptoms, dizziness   
41 Returns to pre-tension   
  Manipulation   
42 Rotational impulse to uninvolved side   
43 Manipulation in expiration   
  3. Lumbar spine Correct Incorrect
  a) Three-Step-Diagnosis   
44 Locates point of irritation (IP) (one finger’s breadth lateral of the spinous process)   
45 Consults the patient for pain   
  Segmental hypomobility   
46 Palpates the spinous processes (three adjacent vertebrae)   
47 Checks rotation   
48 Checks flexion   
  Response of the IP to movement   
49 Patient is in prone position   
50 Palpates IP   
51 Checks rotation (lifts pelvis/shoulder on one side)   
52 Consults the patient for increase/decrease in pain intensity and change in consistency of the IP during movement   
  b) Counter-rotation manipulation   
53 Patient lies on their side   
54 Rotation-sensitive side up   
55 Patient is positioned on the edge of the exam table   
56 hip and knee of upper leg is flexed (90°)   
57 Examiner’s thigh secures tibial head of the patient   
58 Counter-rotation of the spine   
  Hand placement   
59 Index and Ringfinger guide the Middlefinger   
60 Places finger on the spinous process of the segment to be assessed   
61 Places arm on Os ilium   
62 Aligns arm with patient’s back (bridging)   
63 Builds up pre-tension   
  Test traction   
64 Applies traction   
65 Consults the patient for increase in pain intensity, other symptoms, dizziness   
66 Returns to pre-tension   
  Manipulation   
67 Rotational impulse to uninvolved side   
68 Manipulation in expiration   
  4. Sacroiliac joint Correct Incorrect
  a) Three-Step-Diagnosis   
69 Patient is in prone position   
70 Locates point of irritation (IP)   
71 three finger’s breadth lateral of the posterior superior iliac spine (PSIS)   
72 four finger’s breadth caudal of the iliac crest   
  Segmental hypomobility   
73 Patient stands upright   
74 Examiner is positioned behind the patient   
75 Places left thumb on left ASIS   
76 Places right thumb on right ASIS   
77 Asks patient to bend slowly forward   
78 Monitors PSIS downward motion on affected side   
  Response of the IP to movement   
79 Patient is in prone position   
80 Examiner is positioned behind the patient   
81 Palpates IP   
82 Checks cranialisation   
83 Checks caudalisation   
84 Checks ventralisation   
85 Checks dorsalisation   
86 Consults the patient for increase/decrease in pain intensity and change in consistency of the IP during movement   
  b) Panther’s jump technique   
87 Patient is in prone position   
88 Patients’ legs hang over the edge of the table   
89 Examiner is positioned at the foot of the table   
  Hand placement   
90 Affected leg is fixed between examiner’s lower thighs   
91 Uses ulnar edge of hand   
92 Places hand from a caudal direction on the affected side of the sacrum   
93 Places the other hand on top of the first   
  Builds up pre-tension   
94 → Applying traction by carefully moving backwards   
95 → Applying tangential force on the sacrum   
  Test traction   
96 Applies traction   
97 Consults the patient for increase in pain intensity, other symptoms, dizziness   
98 Returns to pre-tension   
  Manipulation   
99 Short thrust to uninvolved side   
100 Manipulation in expiration   
  Result