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Premanipulative vertebrobasilar insufficiency tests

A systematic review of diagnostic accuracy studies has been performed to evaluate the diagnostic accuracy of the premanipulative vertebrobasilar insufficiency (VBI) tests.
Relevance 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.
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.
Based on this systematic review of only 4 studies (1677 potential citations) 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.

Manual Therapy 18 (2013) 177-182

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