Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests
Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests
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DOI：
10.1136/bjsports-2012-091066
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发表时间：
2012-11-01
影响因子：
18.4
通讯作者：
Hegedus, Eric J.
中科院分区：
文献类型：
--
作者：
Hegedus, Eric J.
目的对已发表的肩关节体检文献进行系统回顾和荟萃分析，以确定各项检查的临床实用性。方法本综述是对前人工作的更新，因此Medline和CINAHL检索策略中的术语保持不变，仅限于2006年11月至2012年2月。之前的研究日期是1966-2006年10月。此外，最初的搜索范围扩大了，没有日期限制，包括两个新的数据库：EMBASE和Cochrane图书馆。诊断准确性研究的质量评估，第2版(QUADAS 2)工具被用来评价每一篇新论文的质量。在适当的情况下，将先前综述和本次综述的数据结合起来，使用更新的分级汇总接受者操作特征和双变量模型进行荟萃分析。结果自2008年综述发表以来，又有32项研究被确定和评价。对于肩峰下撞击，Meta分析显示Neer试验的综合敏感性和特异性分别为72%和60%，Hawkins-Kennedy试验分别为79%和59%，疼痛弧度分别为53%和76%。Meta分析还显示，对于上唇前后部撕裂，敏感性最好的试验(52%)是移位试验，特异性最好的试验(95%)是耶尔加森试验，阳性似然比最好的试验(2.81)是压缩旋转试验。关于新的(这一系列综述)ShPE测试，由于缺乏足够的研究或研究之间的异质性而无法进行荟萃分析，有一些单独的测试值得进一步研究。来自低偏倚研究的高特异度试验(特异度80%，LR+>；=5.0)是针对SLAP损伤的被动分散试验。这项测试可能会判定为阳性的巴掌病变。敏感度试验(敏感度80%，LR-
Objective To update our previously published systematic review and meta-analysis by subjecting the literature on shoulder physical examination (ShPE) to careful analysis in order to determine each tests clinical utility.Methods This review is an update of previous work, therefore the terms in the Medline and CINAHL search strategies remained the same with the exception that the search was confined to the dates November, 2006 through to February, 2012. The previous study dates were 1966 - October, 2006. Further, the original search was expanded, without date restrictions, to include two new databases: EMBASE and the Cochrane Library. The Quality Assessment of Diagnostic Accuracy Studies, version 2 (QUADAS 2) tool was used to critique the quality of each new paper. Where appropriate, data from the prior review and this review were combined to perform meta-analysis using the updated hierarchical summary receiver operating characteristic and bivariate models.Results Since the publication of the 2008 review, 32 additional studies were identified and critiqued. For subacromial impingement, the meta-analysis revealed that the pooled sensitivity and specificity for the Neer test was 72% and 60%, respectively, for the Hawkins-Kennedy test was 79% and 59%, respectively, and for the painful arc was 53% and 76%, respectively. Also from the meta-analysis, regarding superior labral anterior to posterior (SLAP) tears, the test with the best sensitivity (52%) was the relocation test; the test with the best specificity (95%) was Yergason's test; and the test with the best positive likelihood ratio (2.81) was the compression-rotation test. Regarding new (to this series of reviews) ShPE tests, where meta-analysis was not possible because of lack of sufficient studies or heterogeneity between studies, there are some individual tests that warrant further investigation. A highly specific test (specificity >80%, LR+ >= 5.0) from a low bias study is the passive distraction test for a SLAP lesion. This test may rule in a SLAP lesion when positive. A sensitive test (sensitivity >80%, LR-