Article

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. 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 x 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.

Langue : ANGLAIS