Cook Chad E, Wilhelm Mark, Cook Amy E, Petrosino Christopher, Isaacs Robert
Division of Physical Therapy, Walsh University, North Canton, OH 44720, USA.
J Manipulative Physiol Ther. 2011 Oct;34(8):539-46. doi: 10.1016/j.jmpt.2011.08.008. Epub 2011 Sep 6.
The purpose of this review was to investigate the diagnostic accuracy for screening and confirmation of clinical tests for cervical spine myelopathy (CSM) and to investigate the quality of the studies that have investigated these values.
This study was a systematic review that used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search terms for PubMed included myelopathy; diagnosis, differential; sensitivity and specificity; and physical examination. Search terms for Cumulative Index to Nursing and Allied Health Literature were limited to myelopathy and sensitivity and specificity. Qualitative assessment included report of diagnostic accuracy metrics (sensitivity, specificity, and positive and negative likelihood ratios) and quality scores using the Quality Assessment of Diagnostic Accuracy Studies tool. Scores were created for single tests and clustered test findings.
After evaluation, 12 full-text articles were selected, scored, and tabulated. Nearly all of the 18 tests demonstrated high levels of specificity and low levels of sensitivity, suggesting that they are poor screening tools. Only one study was scored as high quality. One study involved clustering of test findings but was considered low quality.
Nearly all of the clinical tests for CSM seem to be poor screening tools, which implies that manually oriented clinicians may perform treatment methods in a situation of doubt or uncertainly. More high-quality studies are needed, and manual therapists need to be cognizant that the current clinical tests for CSM lack strong diagnostic accuracy measures that are necessary for clinical decision making.
本综述的目的是调查用于筛查和确诊颈椎病性脊髓病（CSM）的临床检查的诊断准确性，并调查研究这些值的研究的质量。
本研究是一项系统综述，采用系统评价和Meta分析的首选报告项目指南。PubMed的检索词包括脊髓病；诊断、鉴别；敏感性和特异性；以及体格检查。护理学与健康相关文献累积索引的检索词仅限于脊髓病以及敏感性和特异性。定性评估包括诊断准确性指标（敏感性、特异性以及阳性和阴性似然比）的报告，以及使用诊断准确性研究质量评估工具的质量得分。为单项检查和综合检查结果创建得分。
经评估，选择了12篇全文文章，进行评分并制成表格。18项检查中几乎所有检查都显示出高特异性和低敏感性，表明它们是较差的筛查工具。只有一项研究被评为高质量。一项研究涉及综合检查结果，但被认为质量较低。
几乎所有CSM的临床检查似乎都是较差的筛查工具，这意味着以手法治疗为主的临床医生可能在存在疑问或不确定的情况下实施治疗方法。需要更多高质量的研究，手法治疗师需要认识到，目前CSM的临床检查缺乏临床决策所需的强有力的诊断准确性指标。
