The reliability of palpating the posterior superior iliac spine: a systematic review.

Among pelvic landmarks routinely palpated by manual therapists, the posterior superior iliac spines (PSISs) are particularly important. In addition to serving as landmarks for identifying possible pelvic torsion, contacting the PSISs is integral to many other static and dynamic pelvic palpatory procedures. The primary study goal was to systematically review the literature on the intra- and interexaminer reliability of PSIS palpation.Electronic databases and secondary searches led to the retrieval of articles that satisfied inclusion criteria. Two investigators rated the quality of included articles using the QAREL instrument.The search identified 13 articles, one judged high quality, satisfying the inclusion criteria. Intraexaminer exceeded interexaminer reliability. Among 8 studies that reported interexaminer agreement using kappa, mean ϰ=0.27 (adjusted for sample size).Current methods of palpating for PSIS asymmetry do not result in levels of interexaminer reliability supporting clinical utility. Improved methods should be sought.Abstract available from the publisher.