Figure 1. Flowchart of literature review process ... · PDF file105 Figure 1. Flowchart of...
Transcript of Figure 1. Flowchart of literature review process ... · PDF file105 Figure 1. Flowchart of...
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Figure 1. Flowchart of literature review process (Questions 1 & 2)
Medline search(427 citations)
Papers retrieved(225)
Preliminaryincluded papers
(24)
Excluded papers(200)
1a(11)
Clinicaltests
1b(13)
Clinical &Electrodiagnostic
tests
Phase IScreening(abstracts)
Phase IIScreening(full-text)
Studies eligible fordata extraction (by
question)
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Figure 2. Flowchart of literature review process (Question 3)
Medline search(1710 citations)
Papers retrieved(333)
Preliminaryincluded papers
(35)
Excluded papers(295)
Q3(35)
Phase IScreening(abstracts)
Phase IIScreening(full-text)
- 1576 Excluded abstracts+ 199 Papers identified fromother questions and manualbibilographic checks
Studies eligible fordata extraction (by
question)
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Figure 3. Flowchart of literature review process (Question 4)
Medline search(1710 citations)
Papers retrieved (97)
Preliminaryincluded papers
(33)
Excluded papers(64)
Q4a(2)
Q4b(2)
Q4 a&b(20)
Phase IScreening(abstracts)
Phase IIScreening(full-text)
- 1635 Excluded abstracts+ 22 Papers identified fromother questions and manualbibilographic checks
Studies eligible fordata extraction (bypercent of patientswith positive testsand outcomes )
Excluded(2)
Q4b(14)
Studies eligible fordata extraction (by
pre- and post-surgical NCS
means)
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Figure 4. Flowchart of literature review process (Question 5)
Medline search(1710 citations)
Papers retrieved (33)
Preliminaryincluded papers
(20)
Excluded papers(12)
Steroid(12)
Splint(5)
Ergonomics(1)
Phase IScreening(abstracts)
Phase IIScreening(full-text)
- 1690 Excluded abstracts+ 13 Papers identified fromother questions and manualbibilographic checks
Studies eligible fordata extraction (by
treatment)
"Other" Scalesof Relief
Assessment(2)
BostonQuestionnaire
(3)
VAS(1)
VAS+BQ(1)
NSS(1)
VAS+NSS+SSS(1)
VAS+FSS+SSS(1)
BostonQuestionnaire
(1)
SSS(1)
VAS+BQ(1)
NSS(1)
VAS+NSS+SSS(1)
"Other" Scalesof Relief
Assessment(1)
FSS+SSS(2)
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Figure 4.1. Studies on clinical tests
Figure 4.2. Studies on electrodiagnostic tests
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Figure 4.3. Studies on signs/symptoms
Figure 4.4. Studies on median nerve electrodiagnostic tests
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Figure 4.5. Studies on comparative electrodiagnostic tests
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Figure 5. Level of evidence of studies addressing questions 1 & 2
Figure 6. Level of evidence of studies addressing question 3
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Figure 7. Level of evidence of studies addressing question 4
Figure 8. Level of evidence of studies addressing question 5
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Figure 9. Types of study design that compare CTS diagnostic tests
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Figure 10. All tests
Figure 11. Case-control study design (electrodiagnostic and clinical tests)
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Figure 12. Cohort study design (electrodiagnostic and clinical tests)
Figure 13. Cross sectional study design (electrodiagnostic and clinical tests)
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Figure 14. Electrodiagnostic tests case-control study design
Figure 15. Clinical tests case-control study design
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Figure 16. Clinical/Psychomotor tests
Figure 17. Flick, Thenar sign
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Figure 18. Pinch strength
Figure 19. Provocative tests
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Figure 20. Carpal compression tests
Figure 21. Phalen’s test
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Figure 22. Tinel’s sign
Figure 23. Pressure provocative tests
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Figure 24. Sensory tests
Figure 25. Touch tests
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Figure 26. Vibrometry
Figure 27. Two-point discrimination, Semmes-Weinstein monofilament, ridge/gap detection
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Figure 28. Systematic
Figure 29. Median mixed nerve – ulnar mixed nerve
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Figure 30. Ulnar comparative amplitude
Figure 31. Ulnar comparative latency
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Figure 32. Median motor – ulnar motor
Figure 33. Second lumbrical –Interosseous (2L-INT)
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Figure 34. Thenar studies
Figure 35. Median sensory – ulnar sensory: wrist to ring finger
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Figure 36. Sensory ulnar latency comparative
Figure 37. Sensory ulnar velocity comparative
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Figure 38. Median sensory – radial sensory: wrist-to-thumb
Figure 39. Radial comparative velocity
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Figure 40. Radial comparative latency
Figure 41. Median sensory – median mixed wrist to palm vs. forearm to digit
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Figure 42. Segment comparison ratio
Figure 43. Segment comparison latency
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Figure 44. Median motor – wrist to palm
Figure 45. Median motor – APB-DML
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Figure 46. Median motor – DML amplitude, Non-APB DML
Figure 47. Unique tests
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Figure 48. Median sensory/median mixed – wrist to palm
Figure 49. Median sensory/median mixed – wrist to palm test velocity
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Figure 50. Median sensory/median mixed – DSL
Figure 51. Median sensory – wrist to palm
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Figure 52. Median sensory velocity D2 to wrist, sensory amplitude digit, sensory velocity digit
Figure 53a. Sensory latency digit 1 to wrist
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Figure 53b. Sensory latency digit 2 to wrist
Figure 54. Sensory latency digit 3 to wrist
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Figure 55. Sensory latency digit 4 to wrist
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Figure 56. Case Control Studies Grouped by EDT: “Comparison of Median to Ulnar Sensory nerves, wrist-to-ring finger”
Figure 57. Case Control Studies Grouped by EDT: “Median Motor nerve, wrist-to-palm”
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Figure 58. Case Control Studies Grouped by EDT: “Median Motor nerve, wrist-to-palm” measuring DML
Figure 59. Case Control Studies Grouped by EDT: “Median Sensory/Mixed nerve, wrist-to palm”
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Figure 60. Case Control Studies Grouped by EDT: “Median Sensory/Mixed nerve, wrist-to-palm” measuring DSL
Figure 61. Case Control Studies Grouped by EDT: “Median Sensory/Mixed nerve, wrist-to-palm” measuring wrist-to-palm velocity
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Figure 62. Case Control Studies Grouped by EDT: “Median Sensory nerve, wrist-to-digit”
Figure 63. Case Control Studies Grouped by EDT: “Comparison of Median nerve, wrist-to-palm segment to other Median nerve segment (i.e. elbow-to-wrist, palm-to-digit)”
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Figure 64. Cohort Studies Question 3: Relationship between Symptoms and EDT
Figure 65. Cross Sectional Studies Question 3: Relationship between Symptoms and EDT
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Figure 66. Cross Sectional Studies Grouped by EDT: “Combination of two or more EDT or NCS”
Figure 67. Cross Sectional Studies Grouped by EDT: “Comparison of Median to Ulnar Sensory nerves, wrist to digit”
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Figure 68. Cross Sectional Studies Grouped by EDT: “Median Nerve Inching (White, et al. only)”
Figure 69. Cross Sectional Studies Grouped by EDT: “Median Sensory/Mixed nerve, wrist-to-palm”
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Figure 70. Cross Sectional and Cohort Studies
Figure 71. Cross Sectional and Cohort Studies Grouped by EDT: “Combination of two or more EDT or NCS”
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Figure 72. Cross Sectional and Cohort Studies Grouped by EDT: “Comparison of Median to Ulnar Sensory nerves, wrist to digit” measuring latency difference
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Figure 73. Cross Sectional and Cohort Studies Grouped by EDT: “Median Nerve Inching (White, et al. only)”
Figure 74. Cross Sectional and Cohort Studies Grouped by EDT: “Median Sensory/Mixed nerve, wrist-to-palm”
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Figure 75. Cross Sectional and Cohort Studies Grouped by EDT: “Median Sensory/Mixed nerve, wrist-to-palm” measuring wrist-to-palm velocity
Figure 76. ROC Space Combination of two or more EDT or NCS
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Figure 77. ROC Space Comparison of Median to Ulnar Sensory nerves, wrist-to-digit
Figure 78. ROC Space Median Sensory/Mixed nerve, wrist-to-palm
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Figure 79. ROC Space Median Nerve Inching
Figure 80a. ROC Space Median Sensory/Mixed nerve, wrist-to-palm
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Figure 80b. ROC Space median motor nerve, wrist-to-palm measuring DML
Figure 81. ROC Space Median Sensory nerve, wrist-to-digit
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Figure 82. ROC Space Comparison of Median to Radial Sensory nerves, wrist-to-thumb
Figure 83. ROC Space Comparison of Median nerve, wrist-to-palm segment to other Median nerve segment (i.e. elbow-to-wrist, palm-to-digit)
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Figure 84. ROC Space Median Motor nerve TLI
Figure 85. Case-Control Studies Question 3: Relationship between Symptoms and EDT
1-specificity
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Figure 86. Case Control Studies Grouped by EDT: “Combination of two or more EDT/NCS”
Figure 87. Case Control Studies Grouped by EDT:“Comparison of Median to Ulnar Mixed nerves, wrist-to-palm”
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Figure 88. Case Control Studies Grouped by EDT: “Comparison of Median to Ulnar Mixed nerves, wrist-to-palm” and measuring latency difference
Figure 89. Case Control Studies Grouped by EDT: “Comparison of Median to Ulnar Motor nerves”
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Figure 90. Case Control Studies Grouped by EDT: “Comparison of Median to Ulnar Motor nerves” comparing 2nd Lumbrical to Interosseous
Figure 91. Case Control Studies Grouped by EDT: “Comparison of Median to Ulnar Motor nerves” comparing thenar muscles
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Figure 92. Case Control Studies Grouped by EDT: “Comparison of Median to Radial Sensory nerves, wrist-to-thumb”
Figure 93. Case Control Studies Grouped by EDT: “Comparison of Median to Ulnar Sensory nerves, wrist-to-digit”
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Figure 94. Case Control Studies Grouped by EDT: “Comparison of Median to Ulnar Sensory nerves, wrist-to-digit” measuring latency difference
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Figure 95. Summary of findings as reported by study authors
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Figure 96. Correlation of positive surgical outcomes with positive clinical tests
Figure 97. Correlation of positive surgical outcomes with positive electrodiagnostic tests
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Figure 98. Correlation of positive surgical outcomes with positive clinical plus electrodiagnostic tests
Figure 99. Meta-regression of positive surgical outcomes with positive clinical plus electrodiagnostic tests
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Figure 100
Figure 101
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Figure 102
Figure 103
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Figure 104. Magnetic resonance imaging (MRI) - Sensitivity
Sensitivity0 0.2 0.4 0.6 0.8 1
Seyfert 1.00 (0.79 - 1.00)Jarvik 0.92 (0.83 - 0.97)Kleindienst 0.98 (0.91 - 1.00)Keberle 1.00 (0.78 - 1.00)Zagnoli 0.72 (0.55 - 0.86)
Sensitivity (95% CI)
Pooled Sensitivity = 0.91 (0.87 to 0.95)Chi-square = 21.71; df = 4 (p = 0.0002)Inconsistency (I-square) = 81.6 %
Summary Sensitivity Study | Sen [95% Conf. Iterval.] TP/(TP+FN) TN/(TN+FP) -------------------------------------------------------------------------------------------- Seyfert | 1.000 0.794 - 1.000 16/16 5/8 Jarvik | 0.919 0.832 - 0.970 68/74 13/46 Kleindienst | 0.982 0.906 - 1.000 56/57 0/1 Keberle | 1.000 0.782 - 1.000 15/15 13/19 Zagnoli | 0.722 0.548 - 0.858 26/36 22/24 -------------------------------------------------------------------------------------------- Pooled Sen | 0.914 0.866 - 0.949 -------------------------------------------------------------------------------------------- Heterogeneity chi-squared = 21.71 (d.f.= 4) p = 0.000 Inconsistency (I-square) = 81.6 % No. studies = 5. Filter OFF Add 1/2 to all cells of the studies with zero
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Figure 105. Magnetic resonance imaging (MRI) - Specificity
Specificity0 0.2 0.4 0.6 0.8 1
Seyfert 0.63 (0.24 - 0.91)Jarvik 0.28 (0.16 - 0.43)Kleindienst 0.00 (0.00 - 0.98)Keberle 0.68 (0.43 - 0.87)Zagnoli 0.92 (0.73 - 0.99)
Specificity (95% CI)
Pooled Specificity = 0.54 (0.44 to 0.64)Chi-square = 32.37; df = 4 (p = 0.0000)Inconsistency (I-square) = 87.6 %
Summary Specificity Study | Spe [95% Conf. Iterval.] TP/(TP+FN) TN/(TN+FP) -------------------------------------------------------------------------------------------- Seyfert | 0.625 0.245 - 0.915 16/16 5/8 Jarvik | 0.283 0.160 - 0.435 68/74 13/46 Kleindienst | 0.000 0.000 - 0.975 56/57 0/1 Keberle | 0.684 0.434 - 0.874 15/15 13/19 Zagnoli | 0.917 0.730 - 0.990 26/36 22/24 -------------------------------------------------------------------------------------------- Pooled Spe | 0.541 0.437 - 0.642 -------------------------------------------------------------------------------------------- Heterogeneity chi-squared = 32.37 (d.f.= 4) p = 0.000 Inconsistency (I-square) = 87.6 % No. studies = 5. Filter OFF Add 1/2 to all cells of the studies with zero
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Figure 106. Magnetic resonance imaging (MRI) – ROC curve
Sensitivity SROC Curve
1-specificity0 0.2 0.4 0.6 0.8 10
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Symmetric SROCAUC = 0.8463SE(AUC) = 0.0338Q* = 0.7777SE(Q*) = 0.0318
Analysis Options:Add 1/2 to all cells of the studies with zero Filter OFFSymmetric SROC curve fitted using Mantel-Haenszel ModelDefined relevant region:All ROC spac