Specificity, sensitivity, and predictive values of clinical tests of the sacroiliac joint: a systematic review of the literature.

OBJECTIVE To determine which physical examination tests have the highest sensitivity, specificity, and predictive values for determining the presence of sacroiliac joint injuries and/or dysfunction when compared with the gold standard of a sacroiliac joint block. DATA SOURCES A systematic search of the literature was conducted for articles that evaluated clinical sacroiliac joint tests for sensitivity, specificity, and predictive value when compared to sacroiliac joint block. The search was conducted using several online databases: Medline, Embase, Cinahl, AMED, and the Index to Chiropractic Literature. Reference and journal searching and contact with several experts in the area was also employed. DATA EXTRACTION Studies selected for inclusion were evaluated with a data extraction sheet and assessed for methodological quality using an assessment tool based on accepted principles of evaluation. DATA SYNTHESIS Article results were compared, no attempt to formally combine the results into a meta-analysis was made. RESULTS Seven papers were identified for inclusion in the review, two of which dealt with the same study, thus six studies were to be assessed although one paper could not be obtained. The most recently published article had the highest methodological quality. Study designs rarely incorporated randomized, placebo controlled, double blinded study designs or confirmatory sacroiliac joint blocks. There was considerable inconsistency between studies in design and outcome measurement, making comparison difficult. Five tests were found to have sensitivity and specificity over 60% each in at least one study with at least moderately high methodological quality. Using several tests and requiring a minimum number to be positive yielded adequate sensitivity and specificity for identifying sacroiliac joint injury when compared with sacroiliac joint block. CONCLUSION Practitioners may consider using the distraction test, compression test, thigh thrust/posterior shear, sacral thrust, and resisted hip abduction as these were the only tests to have specificity and sensitivity greater than 60% in at least one study. Further research using improved methodology is required to determine the optimal tests and combinations of tests to identify sacroiliac joint injuries.