Table 1. Summary of included studies dealing with the reliability of diagnosis in cranial osteopathy.

First authors	Subjects (number; disease status; age in yrs)	Raters (number ; degree(s) ; expertise)	Study Characteristics & Parameter(s)	Reliability Measure Used	Main Results
Upledger [24]	N = 25 ; not reported; A = 3–5	N = 4 ; one DO (founder of CST) and three MDs; one trained by the CST founder and two considered as “skilled examiners”	Inter-examiner : (1) CRI-F;  (2) restriction of motion in several areas (19 modalities)	Reliability coefficient (no more information)	inter: (1) : missing data; (2) : coefficient ranged from 0 to 1 for all modalities and examiners
Wirth-Pattullo [25]	N = 12; history of trauma, surgery, or “learning disabilities” ; A = 10–62	N = 3 (X, Y and Z) ; PT trained in CST ; 2–4 yrs	Inter-rater : cranial motion F	ICC (2,1)	inter: X-Y: -0.33 ; X-Z: -0.,60 ; ;Y-Z: 0.49 ; X-Y-Z: -0.2
Norton [26]	N = 9 ; healthy ; A = 22–28	N = 6 ; MD-DO ; “extensive training and experience in cranial osteopathy”	• intra-rater of : (1)flexion-duration of the CR ; and (2)duration of cranial cycles (second) • inter-rater : CR-F (cpm)	Pearson product-moment correlation coefficient	• intra : (1) : missing data; (2) • inter : -0.32 to -0.28
Hanten [27]	N = 30 ; any disease or trauma about the skull or spine ; A = 22–54	N = 2 (X & Y) ; PT students ; 11 months	Intra & inter-rater : CR-F	ICC (1,1)	• intra : X : 0.78 ; Y : 0.83 • inter : 0.22
Rogers [28]	N = 28 ; healthy ; A = 18–48	N = 2 (X & Y) ; one PT & one RN trained in CST ; : 5 & 17 yrs respectively	Intra & inter-rater : CR-F to the head and feet	ICC (2,1)	• intra : X : 0.18 for head and 0.30 for feet ; Y : 0.27 for head and 0.29 for feet • inter : 0.08 (head) and0.19 (feet)
Vivian [29]	N = 48 ; not reported; some subjects could have chronic or recurrent pain ; A = 7–63	N = 2 ; DO ; 12 & 15 yrs	Inter-rater of : (1) presence of a partially flexion-restricted motion of the skull ; (2) presence of a total flexion-restriction motion of the skull	Cohens's kappa	inter : (1) : -0.02 ; (2) : -0.09.
Moran [30]	N = 11 ; healthy ; A = 18–44	N = 2 ("X” & “Y”) ; DO ; 4.5 & 6.5 yrs	Intra & inter-rater of : CRI-F to the head and/or sacrum	ICC (2,1)	• intra X : 0.65 for sacrum; 0.47 for head; Y : 0.52 for sacrum; 0.73 for head • inter : 0.0 for X and Y to the head and 0.05 for X and Y to the sacrum
Sommerfeld [31]	N = 49 ; healthy ; A = 19–61	N = 2 ; DO ; 7 yrs	Intra & inter-rater of : PRM-frequency ; PRM flexion-stage duration ; ratio of the flexion-stage and the extension-stage duration of the PRM	95 % limit of agreement (Visual representation)	intra & interexaminer agreement could not be described beyond chance agreement.
Halma [32]	N = 48 ; 16 asthma, 17 headache, 15 healthy ; A : 18–75	N = 2 ; MD-DO ; 14 & 6 yrs	Intra-rater of : (1) CRI-F ; (2) cranial strain patterns ; (3) quadrants of restriction with 4 modalities	Cohens's kappa with 95 % confidence intervals	intra (1) : 0.23 ; (2) : 0.67; (3) : from 0.33 to 0.52 according to modalities

Note: "N": number; "A": age; "DO": doctor of osteopathy; "PT": physical therapist; "RN": registered nurse; "CST": craniosacral therapy; "CRI": cranial rhythmic impulse; "F": frequency; "CR": cranial rhythm; "R": rater; "PRM": primary respiratory mechanism; "ICC": intraclass correlation coefficient