Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements

V. Wirth-Pattullo, K. W. Hayes, J. L. Echternach, K. Ottenbacher

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Background and Purpose. The evaluation of craniosacral motion is an approach used by physical therapists and other health professionals to assess the causes of pain and dysfunction, but evidence for the existence of this motion is lacking and the reproducibility of the results of this palpatory technique has not been studied. This study examined the interexaminer reliability of craniosacral rate and the relationships among craniosacral rate and subjects' and examiners' heart and respiratory rates. Subjects. Participants were 12 children and adults with histories of physical trauma, surgery, or learning disabilities. Three physical therapists with expertise in craniosacral therapy were the examiners. Methods. One of three nurses recorded heart and respiratory rates of both subject and examiner. The examiner then palpated the subject to determine craniosacral rate and reported the findings to the nurse. Each subject was examined by each of the three examiners. Results. Reliability was estimated using a repeated-measures analysis of variance and the intraclass correlation coefficient (2,1). Significant differences among examiners and the scatter plot of rates showed lack of agreement among examiners. The ICC was -.02. The correlations between subject craniosacral rate and subject and examiner heart and respiratory rates were analyzed with Pearson correlation coefficients and were low and not statistically significant. Discussion and Conclusions. Measurements of craniosacral motion did not appear to be related to measurements of heart and respiratory rates, and therapists were not able to measure it reliably. Measurement error may be sufficiently large to render many clinical decisions potentially erroneous. Further studies are needed to verify whether craniosacral motion exists, examine the interpretations of craniosacral assessment, determine the reliability of all aspects of the assessment, and examine whether craniosacral therapy is an effective treatment.

Original languageEnglish (US)
Pages (from-to)908-920
Number of pages13
JournalPhysical therapy
Issue number10
StatePublished - 1994
Externally publishedYes

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation


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