Diagnostic accuracy of upper cervical spine instability tests: a systematic review

Nathan Hutting, Gwendolijne G M Scholten-Peeters, Veerle Vijverman, Martin D M Keesenberg, Arianne P Verhagen

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

BACKGROUND: Patients with neck pain, headache, torticollis, or neurological signs should be screened carefully for upper cervical spine instability, as these conditions are "red flags" for applying physical therapy interventions. However, little is known about the diagnostic accuracy of upper cervical spine instability tests.

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of upper cervical spine instability screening tests in patients or people who are healthy.

DATA SOURCES: PubMed, CINAHL, EMBASE, and RECAL Legacy databases were searched from their inception through October 2012.

STUDY SELECTION: Studies were included that assessed the diagnostic accuracy of upper cervical instability screening tests in patients or people who are healthy and in which sensitivity and specificity were reported or could be calculated using a 2 × 2 table.

DATA EXTRACTION AND QUALITY ASSESSMENT: Two reviewers independently performed data extraction and the methodological quality assessment using the QUADAS-2.

DATA SYNTHESIS: Depending on heterogeneity, statistical pooling was performed. All diagnostic parameters (sensitivity, specificity, predictive values, and likelihood ratios) were recalculated, if possible.

RESULTS: Five studies were included in this systematic review. Statistical pooling was not possible due to clinical and statistical heterogeneity. Specificity of 7 tests was sufficient, but sensitivity varied. Predictive values were variable. Likelihood ratios also were variable, and, in most cases, the confidence intervals were large.

LIMITATIONS: The included studies suffered from several biases. None of the studies evaluated upper cervical spine instability tests in patients receiving primary care.

CONCLUSIONS: The membranes tests had the best diagnostic accuracy, but their applicability as a test for diagnosing upper cervical spine instability in primary care has yet to be confirmed.

Original languageEnglish
Pages (from-to)1686-95
Number of pages10
JournalPhysical Therapy
Volume93
Issue number12
DOIs
Publication statusPublished - Dec 2013

Fingerprint

Spine
Primary Health Care
Torticollis
Sensitivity and Specificity
Neck Pain
PubMed
Headache
Databases
Confidence Intervals
Membranes
Therapeutics

Keywords

  • Cervical Vertebrae
  • Disability Evaluation
  • Humans
  • Joint Instability
  • Mass Screening
  • Sensitivity and Specificity
  • Journal Article
  • Review

Cite this

Hutting, Nathan ; Scholten-Peeters, Gwendolijne G M ; Vijverman, Veerle ; Keesenberg, Martin D M ; Verhagen, Arianne P. / Diagnostic accuracy of upper cervical spine instability tests : a systematic review. In: Physical Therapy. 2013 ; Vol. 93, No. 12. pp. 1686-95.
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Diagnostic accuracy of upper cervical spine instability tests : a systematic review. / Hutting, Nathan; Scholten-Peeters, Gwendolijne G M; Vijverman, Veerle; Keesenberg, Martin D M; Verhagen, Arianne P.

In: Physical Therapy, Vol. 93, No. 12, 12.2013, p. 1686-95.

Research output: Contribution to JournalArticleAcademicpeer-review

TY - JOUR

T1 - Diagnostic accuracy of upper cervical spine instability tests

T2 - a systematic review

AU - Hutting, Nathan

AU - Scholten-Peeters, Gwendolijne G M

AU - Vijverman, Veerle

AU - Keesenberg, Martin D M

AU - Verhagen, Arianne P

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N2 - BACKGROUND: Patients with neck pain, headache, torticollis, or neurological signs should be screened carefully for upper cervical spine instability, as these conditions are "red flags" for applying physical therapy interventions. However, little is known about the diagnostic accuracy of upper cervical spine instability tests.PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of upper cervical spine instability screening tests in patients or people who are healthy.DATA SOURCES: PubMed, CINAHL, EMBASE, and RECAL Legacy databases were searched from their inception through October 2012.STUDY SELECTION: Studies were included that assessed the diagnostic accuracy of upper cervical instability screening tests in patients or people who are healthy and in which sensitivity and specificity were reported or could be calculated using a 2 × 2 table.DATA EXTRACTION AND QUALITY ASSESSMENT: Two reviewers independently performed data extraction and the methodological quality assessment using the QUADAS-2.DATA SYNTHESIS: Depending on heterogeneity, statistical pooling was performed. All diagnostic parameters (sensitivity, specificity, predictive values, and likelihood ratios) were recalculated, if possible.RESULTS: Five studies were included in this systematic review. Statistical pooling was not possible due to clinical and statistical heterogeneity. Specificity of 7 tests was sufficient, but sensitivity varied. Predictive values were variable. Likelihood ratios also were variable, and, in most cases, the confidence intervals were large.LIMITATIONS: The included studies suffered from several biases. None of the studies evaluated upper cervical spine instability tests in patients receiving primary care.CONCLUSIONS: The membranes tests had the best diagnostic accuracy, but their applicability as a test for diagnosing upper cervical spine instability in primary care has yet to be confirmed.

AB - BACKGROUND: Patients with neck pain, headache, torticollis, or neurological signs should be screened carefully for upper cervical spine instability, as these conditions are "red flags" for applying physical therapy interventions. However, little is known about the diagnostic accuracy of upper cervical spine instability tests.PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of upper cervical spine instability screening tests in patients or people who are healthy.DATA SOURCES: PubMed, CINAHL, EMBASE, and RECAL Legacy databases were searched from their inception through October 2012.STUDY SELECTION: Studies were included that assessed the diagnostic accuracy of upper cervical instability screening tests in patients or people who are healthy and in which sensitivity and specificity were reported or could be calculated using a 2 × 2 table.DATA EXTRACTION AND QUALITY ASSESSMENT: Two reviewers independently performed data extraction and the methodological quality assessment using the QUADAS-2.DATA SYNTHESIS: Depending on heterogeneity, statistical pooling was performed. All diagnostic parameters (sensitivity, specificity, predictive values, and likelihood ratios) were recalculated, if possible.RESULTS: Five studies were included in this systematic review. Statistical pooling was not possible due to clinical and statistical heterogeneity. Specificity of 7 tests was sufficient, but sensitivity varied. Predictive values were variable. Likelihood ratios also were variable, and, in most cases, the confidence intervals were large.LIMITATIONS: The included studies suffered from several biases. None of the studies evaluated upper cervical spine instability tests in patients receiving primary care.CONCLUSIONS: The membranes tests had the best diagnostic accuracy, but their applicability as a test for diagnosing upper cervical spine instability in primary care has yet to be confirmed.

KW - Cervical Vertebrae

KW - Disability Evaluation

KW - Humans

KW - Joint Instability

KW - Mass Screening

KW - Sensitivity and Specificity

KW - Journal Article

KW - Review

U2 - 10.2522/ptj.20130186

DO - 10.2522/ptj.20130186

M3 - Article

VL - 93

SP - 1686

EP - 1695

JO - Physical Therapy

JF - Physical Therapy

SN - 0031-9023

IS - 12

ER -