Journal of Rehabilitation Medicine 51-7 | Page 17

486 V. Bélanger et al. from 0.32 to 0.86 and from 0.78 to 0.88 for Yergason’s manoeuvre (37, 47–49, 51) Data from studies assessing Speed test and Yergason’s manoeuvre were pooled (Table V, Fig. 4). The results indicate a widely variable performance for the 2 tests, except for Yergason’s manoeuvre Sp. Sn and Sp for the Speed test are 0.65 (95% CI 0.17–1.00) and 0.61 (95% CI 0.15–1.00) and for Yergason’s manoeuvre 0.41 (95% CI 0.14–0.72) and 0.84 (95% CI 0.65–1.00). DISCUSSION We identified 30 studies evaluating the accuracy of HRUS or OSTs in diagnosing LHBT pathologies (Ta- ble III). The 8 primary studies on HRUS diagnostic accuracy comprised 5 different combinations of target condition/index test. At most, 6 of the studies examined the same combination. The 22 studies assessing OSTs presented 26 such combinations, and no more than 7 research studies tested the same combination. This lack of consistency across studies and the relatively few studies on the subject are a major barrier to the assessment of these clinical tools. Potential of the tests to inform diagnoses For a diagnostic test to be useful, it must have the ability to sufficiently revise the pre-test probability of a patient having a disease in order to guide clinical decisions. HRUS for the diagnosis of dislocation and complete rupture had LR+ above 35.5 and LR– be- low 0.30, indicating a large increase in the post-test probability of dislocation and complete rupture when diagnostic ultrasound is positive, and a moderate decrease in the probability of these diseases when it is negative (23). It should be noted that estimates of Sn of HRUS for diagnosing dislocation and complete rupture had wide confidence intervals (0.15–1.00 and 0.11–1.00), hence their calculated LR– might overplay the evidence. Confidence intervals were narrower for Sp (0.65–1.00 and 0.61–1.00), thus LR+ are probably informative. OSTs LR+ and LR– demonstrated less compel- ling evidence. The only test of value was Yergason’s manoeuvre in diagnosing proximal LHBT pathology except SLAP lesion. Its LR+ was 2.56, indicating a slight increase in the probability of the disease. As its Sp confidence interval was 0.65–1.00, we can assume that it is of reasonable value. OSTs LR– varied between 0.57 and 0.90, all indicating no change in the post-test probability of the disease. The current review separated SLAP I–IV and II–IV lesions as 2 target conditions in order to investigate whether the accuracy of each OST www.medicaljournals.se/jrm changes when SLAP I lesions are considered normal variants. When explored graphically with forest plots, there is no apparent significant difference between the OSTs’ accuracies in diagnosing SLAP I–IV and SLAP II–IV lesions. Comparison with other systematic reviews Eight systematic reviews were identified, of which 4 included a meta-analysis that evaluated the diagnostic accuracy of OSTs for diagnosing SLAP lesions. The 4 systematic reviews that did not include a meta-analysis (6, 7, 9, 12) highlighted that OSTs have a wide range of diagnostic accuracy values, with no particular single test appearing to have strong statistical support. This is in line with our conclusions for the accuracy of OSTs. Hanchard et al. (9) conducted a Cochrane systematic review on shoulder impingements and local lesions of tendons and labrum that may accompany impingement. Their review comprised several individual studies that were included in our analysis for the accuracy of OSTs. For these analyses, Sn and Sp were obtained in agreement with Hanchard et al.’s study. For these same combinations of index test/target condition, 8 new studies issued after completion of their review were identified and included (22, 24–30). In addition, we classified the target conditions slightly differently. In the current review, we grouped together studies examining the diagnosis of SLAP II–IV and SLAP II lesions (our SLAP II–IV group) while Hanchard et al. kept them separated. Four previous meta-analyses (8, 10, 11, 13) have reported pooled accuracy estimates for the active com- pression test, anterior slide test, crank test and Speed test in diagnosing SLAP lesions. Hegedus et al. (10) and Gismervik et al. (8) reviewed the literature on the accuracy of OSTs of the shoulder. For SLAP lesions, there were some discrepancies between the values ob- tained by these authors and our estimates for the active compression test and Speed test. These discrepancies may arise from the fact that we separated SLAP I–IV from II–IV studies. Our higher Sp for active compres- sion test could suggest that it has a better profile for confirming a SLAP II–IV than a SLAP I–IV lesion. In addition, Gismervik et al. incorporated Holtby & Razmjou’s study (31) when combining data for the Speed test, while we did not. It should be noted that Holtby & Razmjou’s study was not included in our analysis for the combination Speed test/SLAP I–IV lesions because this study evaluates Speed test’s ac- curacy in diagnosing not only SLAP lesions, but any proximal LHBT pathology including SLAP lesions. Meserve et al. (11) conducted a meta-analysis exami- ning the accuracy of OSTs for assessing SLAP lesions