title: Diagnostic accuracy of premanipulative vertebrobasilar insufficiency tests: a systematic review.
abstract: METHODS
  A systematic review of diagnostic accuracy studies.
  
  
  OBJECTIVE
  To evaluate the diagnostic accuracy of the premanipulative vertebrobasilar insufficiency (VBI) tests.
  
  
  BACKGROUND
  The aim of premanipulative vertebrobasilar testing is to evaluate the adequacy of blood supply to the brain, by compressing the vertebral artery and examining for the onset of signs and symptoms of cerebrovascular ischemia. Although clinicians consider pre-manipulative testing important before applying spinal manipulations, the diagnostic accuracy has not been systematically reviewed.
  
  
  METHODS
  A search was made in PUBMED, CINAHL and EMBASE databases from their date of inception until 2nd May 2012. Studies were included if they compared a VBI test with a reference test, and sensitivity and specificity were reported or could be calculated. The methodological quality of the studies was evaluated using QUADAS. Agreement between reviewers was calculated and expressed as a percentage and quantified by kappa statistics.
  
  
  RESULTS
  Of the 1677 potential citations only 4 studies were included, all of questionable quality. Sensitivity was low and ranged from 0 to 57%, specificity from 67 to 100%, positive predictive value from 0% to 100%, and negative predictive value from 26 to 96%. The positive likelihood ratio ranged from 0.22 to 83.25 and the negative likelihood ratio from 0.44 to 1.40.
  
  
  CONCLUSIONS
  Based on this systematic review of only 4 studies it was not possible to draw firm conclusions about the diagnostic accuracy of premanipulative tests. However, data on diagnostic accuracy indicate that the premanipulative tests do not seem valid in the premanipulative screening procedure. A surplus value for premanipulative tests seems unlikely.
authors.affiliation: Department of Manual Therapy, Faculty of Medicine and Pharmacology, Vrije Universiteit Brussel, Brussels, Belgium. nhutting@fysiotherapiehetcentrum.nl
authors.forename: Nathan
authors.initials: N
authors.lastname: Hutting
authors.forename: Arianne P
authors.initials: AP
authors.lastname: Verhagen
authors.forename: Veerle
authors.initials: V
authors.lastname: Vijverman
authors.forename: Martin D M
authors.initials: MD
authors.lastname: Keesenberg
authors.forename: Gillian
authors.initials: G
authors.lastname: Dixon
authors.forename: Gwendolijne G M
authors.initials: GG
authors.lastname: Scholten-Peeters
mesh_terms: D001921:Brain / Q000098:blood supply; D006801:Humans; D020393:Manipulation, Spinal; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis* / Q000628:therapy