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Lower extremity Extension Dynamic Test: sensitivity and specificity in diagnosing a leg length inequality (LLI)

Journal: International Journal of Osteopathic Medicine Date: 2006/03, 9(1):Pages: 43. doi: Subito , type of study: cross sectional study

Full text    (https://www.sciencedirect.com/science/article/pii/S174606890600023X)

Keywords:

cross sectional study [597]
extension dynamic test [1]
leg length inequality [10]
sensitivity and specificity [5]
diagnosis [263]

Abstract:

Objective Fundamentally, there are two existing types of leg length inequality theories: the true and the functional; the distinction is crucial to the application of effective treatment. The aim of this research was to estimate the sensibility of Extension Dynamic Test (ED-Test), a variation of the Standing Test, which allows the elimination of adjustments/compensations from low limbs and lumbar extension, incorporating an osteopathic palpatory capacity and the application of osteopathic principles. Results have been compared with those obtained through radiographical studies. Materials/Methods The analysis was performed on 102 subjects who had to undergo a routine medical examination prior to enrolment as an air-force cadet from February 2003 to May 2004 at the Institute of Military Aeronautic, Milan. After signing the agreement of treatment, all the air-force cadets underwent a weight-bearing orthoradiography and the following test. The subjects had to position their feet at a distance of 15cm apart. The operator, from behind the patient, palpates the superior aspect of the greater trochanters and asks the patients to extend their back. The operator evaluates the height differences between the two greater trochanters. Results From the radiographic evaluations, none of the patients tested had the same leg length. Sixty-five percent of the sample presented with a difference >5mm, while 52% had a difference >7mm. The evaluation obtained through ED-Test assessed that 49/102 (48.03%) patients had no LLI; however, these subjects had values of dysmetria at lower levels in comparison to those of the study group (P<0.001). While making a comparison between ED-Test/Radiography, we established a threshold of 5mm and 7mm to compare the influence of the dysmetria on the reliability of the test. In both cases ED-Test showed 58.3% of sensibility and 100% of specificity with a 100% positive predictive value and 68.3% negative predictive value. Discussion The results show that ED-Test had the same efficacy in recognising >5mm and >7mm leg length dysmetrias as radiographic evaluations with predictive values of 90.5% and 97.5%, respectively. This justifies the use of ED-Test as a screening test, with a possible suggestion to patients of an X-ray if confirmation of dysmetria is required.


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