This clearly reported review found that there is a lack of high-quality research on the accuracy of spinal orthopaedic tests, and that it is therefore not appropriate to rely only on such tests. These conclusions should be interpreted with some degree of caution given the limitations of the literature search.

To review the accuracy of orthopaedic tests for the spine and to determine the quality of the available research.

MEDLINE, MANTIS, CINAHL, AMED and the Cochrane Library were searched from inception to December 2005; the search terms, which included a diagnostic filter, were reported. The reference lists of retrieved studies were screened for additional relevant studies. An additional search of MEDLINE was carried out, based on the primary author of included studies. The review was restricted to studies reported in English.

Study designs of evaluations included in the review

Inclusion criteria were not defined in terms of the study design.

Specific interventions included in the review

Studies of physical examination orthopaedic procedures were eligible for inclusion. Studies had to report data for single tests, rather than multidimensional tests reported as a single value. The specific orthopaedic tests evaluated by the included studies were: SI compression, SI distraction, thigh thrust, Gaenslen, sacral thrust, Fabere, posterior shear, resisted abduction, Gillet, SI aggravation, Ely, Yoeman, sacral base spring, Spurling, shoulder abduction, Valsalva, cervical distraction, median N. tension, radial N. tension, Bell, hyperextension, straight leg raise (SLR), crossed SLR, ASLR, pelvic pain, provocation, SI gapping, Adam's forward bend, extension-rotation, Kernig, Brudzkinski, rib-pelvis distance and Hoffmann.

Reference standard test against which the new test was compared

Inclusion criteria were not defined in terms of the reference standard. Details of the reference standards used in the included studies were not specified.

Participants included in the review

Inclusion criteria were not defined in terms of the participants. The conditions evaluated by the included studies were: sacroiliac joint pain/dysfunction, soft cervical disc prolapse, cervical radiculopathy, lumbar disc herniation, cervical spinal cord compression, posterior pelvic pain since pregnancy, scoliosis, vertebrobasilar blood flow, lumbar vertebral fractures, lumbar disc prolapse, meningitis, lumbopelvic pain/dysfunction, lumbosacral radiculopathy and cervical spine/neck pain.

Outcomes assessed in the review

Studies had to report data on the sensitivity and specificity to be included in the review.

How were decisions on the relevance of primary studies made?

Two reviewers independently selected studies for inclusion. Any disagreements were resolved through consensus.

Two reviewers independently assessed studies for methodological quality using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Any disagreements were resolved through consensus. Studies were assigned a score of 1 for each QUADAS item fulfilled, giving a maximum possible score of 14.

Data on the sensitivity and specificity were extracted. The authors did not state how many reviewers performed the data extraction.

How were the studies combined?

Studies were too heterogeneous to permit pooling, therefore a narrative synthesis was presented.

How were differences between studies investigated?

Studies were grouped according to condition and differences between the studies were discussed in the text.

Twenty-one studies (n=7,656) were included in the review.

QUADAS scores ranged from 4 to 12; 29% of studies scored 10 or more.

Studies assessed a wide variety of different conditions using a variety of different tests. Estimates of sensitivity and specificity showed great variation, even when studies assessed the same tests for the same condition.

There is a lack of high-quality research on the accuracy of spinal orthopaedic tests, and it is therefore not appropriate to rely on the results of single tests.

This clearly reported review addressed a focused question that was supported by defined inclusion criteria. The literature search was limited as it included a diagnostic filter and was restricted to English language studies; in addition, attempts to locate unpublished studies were not made. It is therefore possible that relevant studies have been missed and the review may be subject to language and publication bias. A detailed quality assessment was conducted using appropriate criteria and the results of this were reported and considered in the synthesis of the results. Details of the review process included appropriate steps to minimise bias. Only very limited details relating to the included studies were reported, especially in terms of population, reference standard and study design. Given the heterogeneity between the studies, the use of a narrative synthesis was appropriate. The authors' conclusions are supported by the data presented, but should be interpreted with some degree of caution given the limitations of the literature search.

Practice: The authors stated that clinical impressions should not be based on the results of a single test but should consider multiple tests and a good history.

Research: The authors stated the need for high-quality research in this area.

Not stated.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.