Stuber Kent Jason
Private practice, West Springs Chiropractic & Health Centre - 19-8 Weston Drive SW, Calgary, Alberta, Canada.
J Can Chiropr Assoc. 2007 Mar;51(1):30-41.
To determine which physical examination tests have the highest sensitivity, specificity, and predictive values for determining the presence of sacroiliac joint injuries and/or dysfunction when compared with the gold standard of a sacroiliac joint block.
A systematic search of the literature was conducted for articles that evaluated clinical sacroiliac joint tests for sensitivity, specificity, and predictive value when compared to sacroiliac joint block. The search was conducted using several online databases: Medline, Embase, Cinahl, AMED, and the Index to Chiropractic Literature. Reference and journal searching and contact with several experts in the area was also employed.
Studies selected for inclusion were evaluated with a data extraction sheet and assessed for methodological quality using an assessment tool based on accepted principles of evaluation.
Article results were compared, no attempt to formally combine the results into a meta-analysis was made.
Seven papers were identified for inclusion in the review, two of which dealt with the same study, thus six studies were to be assessed although one paper could not be obtained. The most recently published article had the highest methodological quality. Study designs rarely incorporated randomized, placebo controlled, double blinded study designs or confirmatory sacroiliac joint blocks. There was considerable inconsistency between studies in design and outcome measurement, making comparison difficult. Five tests were found to have sensitivity and specificity over 60% each in at least one study with at least moderately high methodological quality. Using several tests and requiring a minimum number to be positive yielded adequate sensitivity and specificity for identifying sacroiliac joint injury when compared with sacroiliac joint block.
Practitioners may consider using the distraction test, compression test, thigh thrust/posterior shear, sacral thrust, and resisted hip abduction as these were the only tests to have specificity and sensitivity greater than 60% in at least one study. Further research using improved methodology is required to determine the optimal tests and combinations of tests to identify sacroiliac joint injuries.
与骶髂关节阻滞这一金标准相比，确定哪些体格检查测试对于判定骶髂关节损伤和/或功能障碍的存在具有最高的敏感性、特异性和预测价值。
对文献进行系统检索，查找那些评估临床骶髂关节测试与骶髂关节阻滞相比的敏感性、特异性和预测价值的文章。检索使用了多个在线数据库：医学索引数据库（Medline）、荷兰医学文摘数据库（Embase）、护理学与健康领域数据库（Cinahl）、联合和补充医学数据库（AMED）以及脊椎按摩疗法文献索引数据库。还进行了参考文献和期刊检索，并与该领域的几位专家进行了联系。
入选的研究使用数据提取表进行评估，并使用基于公认评估原则的评估工具对方法学质量进行评估。
对文章结果进行比较，未尝试将结果正式合并为荟萃分析。
确定有7篇论文纳入该综述，其中2篇涉及同一研究，因此要评估6项研究，尽管有1篇论文无法获取。最新发表的文章方法学质量最高。研究设计很少采用随机、安慰剂对照、双盲研究设计或验证性骶髂关节阻滞。研究在设计和结果测量方面存在相当大的不一致性，难以进行比较。在至少一项方法学质量至少为中等水平的研究中，发现有5项测试的敏感性和特异性均超过60%。与骶髂关节阻滞相比，使用多项测试并要求至少有一定数量的测试呈阳性，对于识别骶髂关节损伤可产生足够的敏感性和特异性。
从业者可考虑使用分离试验、挤压试验、大腿推压/后剪切试验、骶骨推压试验和抗阻髋外展试验，因为这些是至少在一项研究中特异性和敏感性大于60%的仅有的测试。需要采用改进的方法进行进一步研究，以确定识别骶髂关节损伤的最佳测试及测试组合。
