title: Validation of palpatory methods for evaluating anatomical bone landmarks of the cervical spine: a systematic review.
abstract: OBJECTIVE
  The aim of this study was to systematically review the literature for validity of palpatory procedures for evaluating anatomical bone landmarks in the cervical spine.
  
  
  METHODS
  A systematic search of electronic databases identified observational studies assessing validity and/or accuracy regarding evaluation of anatomical bone landmarks of cervical spine palpatory procedures. The databases used in the search included the US National Library of Medicine of the National Institutes of Health (MEDLINE/PubMed), the Regional Library of Medicine (Bireme), the Scientific Electronic Library Online (SciELO), the Physiotherapy Evidence Database (PEDro), the Latin American and Caribbean Health Sciences Literature database (LILACS), the Cochrane Library, and Coordination of Personnel Improvement of Higher Education (CAPES/Brazil). Data were extracted by a primary reviewer, and 2 independent reviewers used a critical appraisal tool to estimate the quality of the retrieved studies. The results were synthesized qualitatively within the Quality Assessment of Diagnostic Accuracy Studies criteria. After completing the synthesis and scoring, the reviewers applied classifications such as "low," "fair," and "good."
  
  
  RESULTS
  The initial search yielded 69860 articles. After selection criteria were applied, 5 studies satisfied the eligibility criteria. Three studies verified the validity of the manual palpatory procedure, and 2 studies correlated the findings of the palpatory procedures with other measured results. According to Quality Assessment of Diagnostic Accuracy Studies criteria, 3 studies presented good methodological quality, and 2 presented fair methodological quality. Studies demonstrated an accuracy range from 51% to 87.8%.
  
  
  CONCLUSIONS
  There are few studies that evaluate the validity of manual palpatory procedures for examining boney landmarks of the cervical spine. The 5 that were found showed fair to good methodological quality. However, we note that there may be poor external validity due to the sampling heterogeneity of these studies.
authors.affiliation: Assistant Professor, Brazilian Institute of Osteopathy (IBO), Rio de Janeiro, Brazil.
authors.forename: Luciana Cid
authors.initials: LC
authors.lastname: Póvoa
authors.affiliation: Professor, Brazilian Institute of Osteopathy (IBO), Rio de Janeiro, Brazil.
authors.forename: Ana Paula Antunes
authors.initials: AP
authors.lastname: Ferreira
authors.affiliation: Professor, Science Rehabilitation Postgraduate Program/Analysis of Human Movement Lab, Augusto Motta University Center (UNISUAM), Rio de Janeiro, RJ, Brazil; Department of Physical Therapy, Manual Therapy Research Group (GETEM/UFRJ), Federal University of Rio de Janeiro (UFRJ), Brazil. Electronic address: jgsilva@hucff.ufrj.br.
authors.forename: Julio Guilherme
authors.initials: JG
authors.lastname: Silva
mesh_terms: D059925:Anatomic Landmarks; D002574:Cervical Vertebrae / Q000033:anatomy & histology*; D006801:Humans; D010173:Palpation / Q000379:methods*
keywords: Cervical Vertebrae; Dimensional Measurement Accuracy; Palpation; Reproducibility of Results