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Diagnostic accuracy of clinical tests for assessment of hamstring injury: a systematic review.

Publication ,  Journal Article
Reiman, MP; Loudon, JK; Goode, AP
Published in: J Orthop Sports Phys Ther
April 2013

STUDY DESIGN: Systematic literature review. BACKGROUND: The diagnosis of a hamstring injury has traditionally relied on various clinical measures (eg, palpation, swelling, manual resistance), as well as the use of diagnostic imaging. But a few studies have suggested the use of specific clinical tests that may be helpful for the diagnostic process. OBJECTIVE: To summarize the current literature on the diagnostic accuracy of orthopaedic special tests for hamstring injuries and to determine their clinical utility. METHODS: A computer-assisted literature search of the MEDLINE, CINAHL, and Embase databases (along with a manual search of grey literature) was conducted using key words related to diagnostic accuracy of hamstring injuries. To be considered for inclusion in the review, the study required (1) patients with hamstring or posterior thigh pain; (2) a cohort, case-control, or cross-sectional design; (3) inclusion of at least 1 clinical examination test used to evaluate hamstring pathology; (4) comparison against an acceptable reference standard; (5) reporting of diagnostic accuracy of the measures (sensitivity [SN], specificity [SP], or likelihood ratios); and (6) publication in English. SN, SP, and positive and negative likelihood ratios were calculated for each diagnostic test. RESULTS: The search strategy identified 602 potential articles, of which only 3 articles met the inclusion criteria, with only 1 of these 3 articles being of high quality. Two of the studies investigated a single special test, whereas the third article examined a composite clinical assessment employing various special tests. The SN values ranged from 0.55 (95% confidence interval [CI]: 0.46, 0.69) for the active range-of-motion test to 1.00 (95% CI: 0.97, 1.00) for the taking-off-the-shoe test. The SP values ranged from 0.03 (95% CI: 0.00, 0.22) for the composite clinical assessment to 1.00 (95% CI: 0.97, 1.00) for the taking-off-the-shoe test, active range-of-motion test, passive range-of-motion test, and resisted range-of-motion test. The use of a single special test demonstrated stronger SP than SN properties, whereas the composite clinical assessment demonstrated stronger SN than SP properties. CONCLUSION: Very few studies have investigated the utilization of clinical special tests for the diagnosis of hamstring injuries. Further studies of higher quality design are suggested prior to advocating independent clinical utilization of these special tests. LEVEL OF EVIDENCE: Diagnosis, level 3b.

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Published In

J Orthop Sports Phys Ther

DOI

EISSN

1938-1344

Publication Date

April 2013

Volume

43

Issue

4

Start / End Page

223 / 231

Location

United States

Related Subject Headings

  • Thigh
  • Soft Tissue Injuries
  • Orthopedics
  • Muscle, Skeletal
  • Humans
  • Cross-Sectional Studies
  • Cohort Studies
  • Case-Control Studies
  • Athletic Injuries
  • 4207 Sports science and exercise
 

Citation

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Reiman, M. P., Loudon, J. K., & Goode, A. P. (2013). Diagnostic accuracy of clinical tests for assessment of hamstring injury: a systematic review. J Orthop Sports Phys Ther, 43(4), 223–231. https://doi.org/10.2519/jospt.2013.4343
Reiman, Michael P., Janice K. Loudon, and Adam P. Goode. “Diagnostic accuracy of clinical tests for assessment of hamstring injury: a systematic review.J Orthop Sports Phys Ther 43, no. 4 (April 2013): 223–31. https://doi.org/10.2519/jospt.2013.4343.
Reiman MP, Loudon JK, Goode AP. Diagnostic accuracy of clinical tests for assessment of hamstring injury: a systematic review. J Orthop Sports Phys Ther. 2013 Apr;43(4):223–31.
Reiman, Michael P., et al. “Diagnostic accuracy of clinical tests for assessment of hamstring injury: a systematic review.J Orthop Sports Phys Ther, vol. 43, no. 4, Apr. 2013, pp. 223–31. Pubmed, doi:10.2519/jospt.2013.4343.
Reiman MP, Loudon JK, Goode AP. Diagnostic accuracy of clinical tests for assessment of hamstring injury: a systematic review. J Orthop Sports Phys Ther. 2013 Apr;43(4):223–231.

Published In

J Orthop Sports Phys Ther

DOI

EISSN

1938-1344

Publication Date

April 2013

Volume

43

Issue

4

Start / End Page

223 / 231

Location

United States

Related Subject Headings

  • Thigh
  • Soft Tissue Injuries
  • Orthopedics
  • Muscle, Skeletal
  • Humans
  • Cross-Sectional Studies
  • Cohort Studies
  • Case-Control Studies
  • Athletic Injuries
  • 4207 Sports science and exercise