![]() ![]() Tuning forks (a two-pronged steel device used by musicians, which vibrates when struck to give a note of specific pitch) can be quite useful at identifying fractures and/or problems with the bone. His ankle was quite swollen and tender on the outside of his foot. He came to the office stating that his left ankle pain was really bothering him and he would like us to start physical therapy treatments. He was diagnosed with peroneal tendinitis and responded well to care very quickly. His right ankle was initially treated because it very painful and debilitating. This patient inspects roofs for an insurance company and spends a great deal of time walking on sloped surfaces. Sensitivity sound transmission specificity.A male in his late 20’s stopped by the clinic with bilateral ankle pain. Despite the lack of strong evidence for diagnosing all fractures, tuning-fork tests may be appropriate in rural and remote settings in which access to the gold standards for diagnosis of fractures is limited. Similarly, the tuning-fork tests were not statistically accurate in the diagnosis of fractures for widespread clinical use. However, strong evidence is lacking to support the use of current tuning-fork tests to rule in a fracture in clinical practice. The studies included in this review demonstrated that tuning-fork tests have some value in ruling out fractures. The positive likelihood ratios ranged from 1.1 to 16.5 the negative likelihood ratios ranged from 0.09 to 0.49. The specificity of the tuning-fork tests had a wide range of 18% to 94%. ![]() The sensitivity of the tuning-fork tests was high, ranging from 75% to 92%. The prevalence of fracture in these patients ranged from 10% to 80% using a reference standard such as magnetic resonance imaging, radiography, or bone scan. The patients ranged in age from 7 to 84 years. The 6 studies assessed the accuracy of 2 tuning-fork test methods (pain induction and reduction of sound transmission). Six primary studies (329 patients) were included in the review. ![]() Data for the primary outcome measure (accuracy of the test) were presented in a 2 × 2 contingency table to show sensitivity and specificity (using the Wilson score method) and positive and negative likelihood ratios with 95% confidence intervals.Ī total of 62 citations were initially identified. A third researcher was consulted if the 2 initial reviewers did not reach consensus. The QUADAS-2 is an updated version of the original QUADAS and focuses on both the risk of bias and applicability of a study through a series of questions. All relevant articles were included and assessed for inclusion criteria and value using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool, and relevant data were extracted. Potentially eligible studies were independently assessed by 2 researchers. Studies were not eligible if they were case series, case-control studies, or narrative review papers. Studies included patients of all ages in all clinical settings with no exclusion for language of publication. Studies were eligible based on the following criteria: (1) primary studies that assessed the diagnostic accuracy of tuning forks (2) measured against a recognized reference standard such as magnetic resonance imaging, radiography, or bone scan and (3) the outcome was reported using pain or reduction of sound. The following key words were used independently or in combination: auscultation, barford test, exp fractures, fracture, tf test, tuning fork. In addition, they manually searched reference lists from the initial search result to identify relevant studies. The authors performed a comprehensive literature search of AMED, CAB Abstracts, CINAHL, EMBASE, MEDLINE, SPORTDiscus, and Web of Science from each database's start to November 2012. 2014 4(8):e005238.ĭoes evidence support the use of tuning-fork tests in the diagnosis of fractures in clinical practice? Is there sufficient evidence for tuning fork tests in diagnosing fractures? A systematic review. Mugunthan K, Doust J, Kurz B, Glasziou P. ![]()
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