The influence of body painting on L4 spinous process palpation accuracy in novice palpators

ABSTRACT

Objectives

Current literature remains inconclusive regarding the best methodology to accurately palpate lumbar spinous processes (SP). Body painting (BP) uses markers to draw anatomical structures on the skin’s surface. While BP can be a useful tool for engaging learners, it is unknown whether it improves palpation accuracy. The purpose of this study was to investigate whether the addition of body painting to palpation education improves lumbar spinous process palpation accuracy in first-year Doctor of Physical Therapy (DPT) students.

Methods

Thirty-eight DPT students were randomized into a traditional palpation group and a body painting (BP) group. Each group received identical instruction on palpating the lumbar spine, with the BP group additionally drawing lumbar SPs on their laboratory partner with a marker. Students were then assessed on their ability to accurately palpate the L4 SP on randomly assigned subjects. Two Certified Registered Nurse Anesthetists (CRNAs) used ultrasound imaging to confirm the location of each student’s palpation. Palpation time was also recorded. The BP group also completed a survey on the learning experience.

Results

Forty-five percent of students were able to accurately palpate the L4 SP. There was no significant difference (p = 0.78) in palpation accuracy between the traditional and BP group, although students in the BP group were randomly assigned subjects with a significantly (p = 0.005) higher BMI. Ninety-five percent of students were able to palpate within one spinal level of the L4 SP. Students in the BP group reported that the BP activity facilitated learning and active participation. There was no significant difference in palpation time (p = 0.98) between groups. There was a fair correlation (r=-0.41) between palpation accuracy and subject BMI.

Discussion/Conclusion

While body painting was an enjoyable activity to incorporate into palpation laboratory, it is unclear whether it enhanced lumbar SP palpation accuracy in first-year DPT students.

KEYWORDS:

• Palpation
• lumbar spinous process
• body painting
• physical therapy

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.

Notes on contributors

William M. Scogin

William M. Scogin, PT, DPT, ScD, is an Assistant Professor of Physical Therapy at Samford University in Birmingham, AL. He is a Board-Certified Orthopaedic Clinical Specialist by the American Board of Physical Therapy Specialists, as well as a Certified Orthopedic Manual Therapist by the International Academy of Orthopedic Medicine – US. His research areas include palpation, chronic pain, and the clinical implications of anatomical variations.

David Sanford

David Sanford, DNP, CRNA, EMT-P is an adjunct professor in the Moffett and Sanders School of Nursing, Department of Nurse Anesthesia at Samford University. In the clinical role, he is chief of operations for nurse anesthesia at Ascension St Vincent's Hosptial in Birmingham, AL.

Mary Beth Greenway

Mary beth Greenway, DNP, CRNA is on faculty at Samford University in the Moffett and Sanders School of Nursing's Nurse Anesthesia Department. She teaches Obstetric Anesthesia, Advanced Health Assessment, and Nursing Education. Her areas of interest include anesthesia in developing countries and obstetric anesthesia.

Maria Ledbetter

Maria Ledbetter, DNAP, CRNA, is an Assistant Professor of Nurse Anesthesia at Samford University in Birmingham, Alabama. She has been a practicing Certified Registered Nurse Anesthetist for 25 years. Her clinical practice is as an Obstetric CRNA in Nashville, TN. Her expertise is in neuraxial anesthesia/analgesia, and her research interests are postdural puncture headache prevention and treatment and non-opioid analgesic adjuvants in labor analgesia.

Nicholas B. Washmuth

Nicholas B. Washmuth, PT, DPT is an Associate Professor of Physical Therapy at Samford University. He is a Board-Certified Orthopaedic Clinical Specialist by the American Board of Physical Therapy Specialist. He teaches in the area of orthopedic physical therapy. His research areas include swearing, erectile dysfunction, anatomy, and biomechanics.