Faculty Opinions recommendation of Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature.

Background: Undiagnosed congenital heart disease in the prenatal stage can occur in approximately 5 to 15 out of 1000 live births; more than a quarter of these will have critical congenital heart disease (CCHD). Late postnatal diagnosis is associated with a worse prognosis during childhood, and there is evidence that a standardized measurement of oxygen saturation in the newborn by cutaneous oximetry is an optimal method for the detection of CCHD. We conducted a systematic review of the literature and meta-analysis comparing the operational characteristics of oximetry and physical examination for the detection of CCHD. Methods: A systematic review of the literature was conducted on the following databases including published studies between 2002 and 2017, with no language restrictions: Pubmed, Science Direct, Ovid, Scopus and EBSCO, with the following keywords: oximetry screening, critical congenital heart disease, newborn OR oximetry screening heart defects, congenital, specificity, sensitivity, physical examination. Results: A total of 419 articles were found, from which 69 were selected based on their titles and abstracts. After quality assessment, five articles were chosen for extraction of data according to inclusion criteria; data were analyzed on a sample of 404,735 newborns in the five included studies. The following values were found, corresponding to the operational characteristics of oximetry in combination with the physical examination: sensitivity: 0.92 (CI 95%, 0.87-0.95), specificity: 0.98 (CI 95%, 0.89-1.00), for physical examination alone sensitivity: 0.53 (CI 95%, 0.28-0.78) and specificity: 0.99 (CI 95%, 0.97-1.00). Conclusions: Evidence found in different articles suggests that pulse oximetry in addition to neonatal physical examination presents optimal operative characteristics that make it an adequate screening test for detection of CCHD in newborns, above all this is essential in low and middle-income settings where technology medical support is not entirely available.

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Ultrasound assessment of the myofascial trigger point. A systematic review

Revista Fisioterapia Invasiva ◽

10.1055/s-0039-3401889 ◽

2019 ◽

Vol 02 (02) ◽

pp. 068-068

Author(s):

López San Miguel G. ◽

Barbe Mendibil I. ◽

Torres Chica B. ◽

Ríos Diaz J.

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Public Health Problem ◽

Trigger Points ◽

Risk Of Bias ◽

Quality Analysis ◽

Lumbar Region ◽

Myofascial Trigger Points ◽

Upper Trapezius ◽

Black Scale

Abstract Introduction Myofascial pain syndrome is an important and prevalent public health problem. The lack of consensus on the diagnostic criteria, together with the scarce reliability of the manual detection of the manual detection of myofascial trigger points (MTrPs) point to the need to develop objective methods to enable confirmation of the presence of MTrPs. Ultrasound is an accessible method which enables the assessment of tissue properties in real time, helping to characterize the MTrP, understand its physiopathology and define its diagnosis. Aims To identify observational studies researching the use of ultrasound in the assessment of MTrPs. Also, to learn about and compile the advances in the study of the characteristics of MTrPs and their sonographic diagnosis. Material and Methods A systematic review was performed by two independent reviewers, searching biomedical databases using terms related with “ultrasound” and “trigger points”. Observational studies were selected evaluating the characteristics of MTrPs. Subsequently, an analysis of the diagnostic quality of studies was performed using the QAREL scale and a study of the methodological quality took place based on the Downs and Black scale. Furthermore, an assessment of the reproducibility of the acquirement of images was performed, via the analysis of the description of the ultrasound method. The risk of bias was evaluated according to the Cochrane guidelines. Results 18 studies based on B Mode methods, elastography and Doppler, were included in the review. The anatomic regions which were most explored were the cervical area and the upper limb, evaluated in 14 of the 18 papers. The most common muscle was the upper trapezius (61%). Two articles were located corresponding to the lumbar region and one article concerned the lower limb. The analysis of the sonographic method showed a low level, 5 of the 9 items did not overcome 17% of fulfillment, in 3 papers the frequency was below 6%. The QAREL scale also displayed low levels, only 3 items out of 11. Inter-evaluator blinding, correct testing and statistical methods were fulfilled in over 50%. The mean score obtained by the studies in the Downs and Black scale was 5.4 points out of 10, ranging between 2 and 7 points. The risk of bias according to the Cochrane guidelines was mid- to high. Conclusion Important steps have been taken in the study of the sonograhic characteristics of the MTrP, however, we are still far from standardizing the use of the same as a diagnostic method. The poor results in the quality analysis of the present study suggest caution in the interpretation of the present findings. Future research is necessary, including different anatomic regions, analytic methods, better defined exploration protocols and more robust reliability studies for the different methods available.

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