The reliability of palpatory examinations for pelvic landmarks to determine pelvic asymmetry: a systematic review and meta-analysis

Abstract

Background

Assessments and treatments focused on pelvic asymmetry are common amongst health professionals. However, there is no clear evidence for the reliability of palpatory examinations for pelvic landmarks.

Objectives

This review aimed to investigate the reliability of palpatory examinations for pelvic landmarks.

Methods

A systematic search was undertaken using eight databases from inceptions to 2021 January 8th, to identify relevant primary studies. Methodological quality of included studies was evaluated using quality appraisal tool for studies of diagnostic reliability (QAREL). Data on kappa statistics were synthesized quantitatively.

Results

10 papers were included. Six papers had moderate methodological quality (50–70% in QAREL). Four pelvic landmarks, including anterior superior iliac spine, posterior superior iliac spine, sacral sulcus or inferior lateral angle were examined. For both inter-rater and intra-rater reliability, kappa statistics were consistently lower than 0.60 regardless of examiners’ qualifications or experience levels, or standardisation trainings. As a result of meta-analyses, pooled kappa statics were consistently lower than 0.06 for all landmarks.

Conclusions

Consistent evidence was found to suggest that palpatory examinations of pelvic landmarks to detect pelvic asymmetry do not have an acceptable reliability. Therefore, the current evidence does not support the use of these tests in clinical or educational settings.

Keywords:

• Pelvic landmarks
• pelvic asymmetry
• palpatory examinations
• reliability
• systematic review

Disclosure statement

The authors declare no conflict of interests.

Funding

The authors reported no funding associated with the work featured in this article.

Additional information

Notes on contributors

Koya Mine

Koya Mine (M Musc & Sports Physio) is a researcher and a clinical physiotherapist and his interests lie in sports and musculoskeletal injuries.

Kenta Ono

Kenta Ono (B HSc) a clinical physiotherapist and his interests lie in upper-limb injuries in baseball.

Nobuhito Tanpo

Nobuhito Tanpo (M HSc) is a clinical physiotherapist and his interests lie in rehabilitation for patients with stroke.