![]() ![]() As the overall diagnostic accuracy of the tests investigated is not strong, based on the calculated likelihood ratios, it is recommended that radiological imaging should continue to be used for the confirmation and diagnosis of stress fractures of the lower limb.ĭiagnosis, level 1a-.J Orthop Sports Phys Ther 2012 42(9):760-771, Epub 19 July 2012. The results of this systematic review do not support the specific use of ultrasound or tuning forks as standalone diagnostic tests for lower-limb stress fractures. Tuning fork test data could not be pooled however, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio ranged from 35% to 92%, 19% to 83%, 0.6 to 3.0, and 0.4 to 1.6, respectively. Meta-analysis was used to statistically analyze the data extracted from the ultrasound articles and demonstrated a pooled sensitivity of 64% (95% confidence interval : 55%, 73%), specificity of 63% (95% CI: 54%, 71%), positive likelihood ratio of 2.1 (95% CI: 1.1, 3.5), and negative likelihood ratio of 0.3 (95% CI: 0.1, 0.9). Nine articles investigating 2 clinical procedures, therapeutic ultrasound (n = 7) and tuning fork testing (n = 2), met the study inclusion criteria. ![]() ![]() Retrieved articles were evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool, and a meta-analysis was performed where appropriate. Physical examination procedures and clinical tests are suggested for diagnosing stress fractures however, data on the diagnostic accuracy of these tests have not been investigated through a systematic review of the literature.Ī systematic review was conducted in 8 electronic databases to identify diagnostic accuracy studies, published between January 1950 and June 2011, that evaluated clinical tests against a radiological diagnosis of lower-limb stress fracture. Stress fractures are a bone-related overuse injury primarily occurring in the lower limb and commonly affecting running athletes and military personnel. The sensitivity of the tuning-fork tests was high, ranging from 75 to 92. The prevalence of fracture in these patients ranged from 10 to 80 using a reference standard such as magnetic resonance imaging, radiography, or bone scan. Tuning fork tests can help to differentiate the type of hearing loss, and can be especially helpful in determining SNHL. To evaluate the diagnostic accuracy of clinical tests to identify stress fractures in the lower limb. The patients ranged in age from 7 to 84 years. Systematic literature review and meta-analysis. ![]()
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