Background: With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation.Methods: Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation.Results: A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement.Conclusions: A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care- methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine such as skin conductance or thermography tend not to be supported by the available evidence.

Objective : We evaluated the feasibility of using mobile device technology to allow students to record their own psychomotor skills so that these recordings can be used for self-reflection and formative evaluation. Methods : Students were given the choice of using DVD recorders, zip drive video capture equipment, or their personal mobile phone, device, or digital camera to record specific psychomotor skills. During the last week of the term, they were asked to complete a 9-question survey regarding their recording experience, including details of mobile phone ownership, technology preferences, technical difficulties, and satisfaction with the recording experience and video critique process. Results : Of those completing the survey, 83% currently owned a mobile phone with video capability. Of the mobile phone owners 62% reported having email capability on their phone and that they could transfer their video recording successfully to their computer, making it available for upload to the learning management system. Viewing the video recording of the psychomotor skill was valuable to 88% of respondents. Conclusions : Our results suggest that mobile phones are a viable technology to use for the video capture and critique of psychomotor skills, as most students own this technology and their satisfaction with this method is high.