Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Rd, Level 2, Sydney, NSW, 2109, Australia.
Faculty of Nursing, University of Montreal, Montreal, 2900, Boul. Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada.
Chiropr Man Therap. 2022 Dec 19;30(1):58. doi: 10.1186/s12998-022-00470-0.
Clinicians rely on certain physical examination tests to diagnose and potentially grade ankle sprains and ankle instability. Diagnostic error and inaccurate prognosis may have important repercussions for clinical decision-making and patient outcomes. Therefore, it is important to recognize the diagnostic value of orthopaedic tests through understanding the reliability and validity of these tests.
To systematically review and report evidence on the reliability and validity of orthopaedic tests for the diagnosis of ankle sprains and instability.
PubMed, CINAHL, Scopus, and Cochrane databases were searched from inception to December 2021. In addition, the reference list of included studies, located systematic reviews, and orthopaedic textbooks were searched. All articles reporting reliability or validity of physical examination or orthopaedic tests to diagnose ankle instability or sprains were included. Methodological quality of the reliability and the validity studies was assessed with The Quality Appraisal for Reliability studies checklist and the Quality Assessment of Diagnostic Accuracy Studies-2 respectively. We identified the number of times the orthopaedic test was investigated and the validity and/or reliability of each test.
Overall, sixteen studies were included. Three studies assessed reliability, eight assessed validity, and five evaluated both. Overall, fifteen tests were evaluated, none demonstrated robust reliability and validity scores. The anterolateral talar palpation test reported the highest diagnostic accuracy. Further, the anterior drawer test, the anterolateral talar palpation, the reverse anterior lateral drawer test, and palpation of the anterior talofibular ligament reported the highest sensitivity. The highest specificity was attributed to the anterior drawer test, the anterolateral drawer test, the reverse anterior lateral drawer test, tenderness on palpation of the proximal fibular, and the squeeze test.
Overall, the diagnostic accuracy, reliability, and validity of physical examination tests for the assessment of ankle instability were limited. Physical examination tests should not be used in isolation, but rather in combination with the clinical history to diagnose an ankle sprain. Preliminary evidence suggests that the overall validity of physical examination for the ankle may be better if conducted five days after the injury rather than within 48 h of injury.
临床医生依赖某些体格检查来诊断和潜在分级踝关节扭伤和踝关节不稳定。诊断错误和不准确的预后可能对临床决策和患者结局产生重要影响。因此，通过了解这些检查的可靠性和有效性，认识到骨科检查的诊断价值非常重要。
系统回顾和报告有关骨科检查用于诊断踝关节扭伤和不稳定的可靠性和有效性的证据。
从开始到 2021 年 12 月，检索了 PubMed、CINAHL、Scopus 和 Cochrane 数据库。此外，还检索了纳入研究的参考文献列表、系统评价和骨科教科书。所有报告体格检查或骨科检查用于诊断踝关节不稳定或扭伤的可靠性或有效性的文章均被纳入。使用可靠性研究质量评估清单和诊断准确性研究-2 分别评估可靠性和有效性研究的方法学质量。我们确定了骨科检查被调查的次数以及每个检查的有效性和/或可靠性。
总共纳入了 16 项研究。3 项研究评估了可靠性，8 项研究评估了有效性，5 项研究同时评估了可靠性和有效性。总共评估了 15 项检查，没有一项检查显示出可靠的可靠性和有效性评分。前外侧距骨触诊试验报告的诊断准确性最高。此外，前抽屉试验、前外侧距骨触诊、反向前外侧抽屉试验和前距腓骨韧带触诊报告的敏感性最高。前抽屉试验、前外侧抽屉试验、反向前外侧抽屉试验、近端腓骨触诊压痛和挤压试验的特异性最高。
总体而言，评估踝关节不稳定的体格检查的诊断准确性、可靠性和有效性有限。体格检查不应单独使用，而应结合临床病史来诊断踝关节扭伤。初步证据表明，如果在受伤后 5 天而不是在受伤后 48 小时内进行，体格检查对踝关节的整体有效性可能会更好。
