Fichter P1, Knicker A1,2, Alfuth M1,3
1German Sport University Cologne, Department of Further Education, M.Sc. Sport Physiotherapy, Cologne, Germany, 2German Sport University Cologne, Institute of Movement and Neuroscience, Cologne, Germany, 3Niederrhein University of Applied Sciences, Faculty of Health Care, Therapeutic Sciences, Krefeld, Germany
Background: Physiotherapists are frequently confronted with leg length discrepancy, which may result in multiple problems for the affected patient. A variety of assessments to determine leg length discrepancy is used, however, evidence about reliability, validity and diagnostic accuracy may differ.
Purpose: To identify and compare the reliability, validity and diagnostic accuracy of different assessments and imaging diagnostics of leg length discrepancy.
Methods: A review of diagnostic studies and reviews was conducted following systematic searches of MEDLINE (PubMed) and INDEX TO CHIROPRACTIC LITERATURE. Studies considered for analysis were selected using the recommendations of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Full-text studies and reviews regarding clinical assessments and imaging diagnostics for the diagnosis of leg length discrepancy which reported the clinimetric properties for assessment of leg length discrepancy were included and screened by two independent reviewers for methodological quality. Further inclusion criteria were English or German language and for studies dealing with clinical assessments a year of publication ≥1983 and for studies regarding imaging diagnostics a year of publication ≥2000 to provide a review of the updated literature. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was completed to evaluate the quality of the diagnostic studies. Thereby, the included studies were categorized as having a “high,” “moderate,” or “low” overall risk of bias or concerns regarding applicability.
Results: The search in PubMed identified 3716 studies and the search in INDEX TO CHIROPRACTIC LITERATURE resulted in 248 studies. After duplicates were removed (n=5), 30 articles on clinical assessments (25 studies; 5 reviews) and 10 studies on imaging diagnostics (9 studies; 1 review) met the eligibility criteria and were finally analyzed. Eight diagnostic studies on clinical assessments and 6 studies of imaging diagnostics had a low risk of bias and low concerns regarding applicability for all domains. For the clinical assessments, the block test showed a higher reliability, sensitivity, and specificity compared with using a tape measure. Leg length measurements in prone and supine positions as well as using devices, such as the PALpation Meter or the pelvic leveling device, demonstrated good reliability as well, however, for the latter two validity was only moderate as compared with imaging diagnostics. For the imaging diagnostics, it was shown, that a teleroentgenogram and a computed tomography scanogram are to be preferred for the initial examination of leg length discrepancy. Reliability of the EOSTM imaging system and pelvic radiography was excellent, however, validity was moderate for the latter. A laser-based ultrasonography had excellent reliability and correlated with a radiographic measurement.
Conclusion(s): For the clinical assessment of leg length discrepancy, the block test appears to be the most useful method followed by using a tape measure. The teleroentgenogram is considered the most convenient method of imaging diagnostics for initial examination. The EOSTM imaging can be recommended for follow-up examinations.
Implications: These findings may have relevance for the selection of clinical assessments to determine leg length discrepancy in clinical practice.
Keywords: Leg length discrepancy, measurement, review
Funding acknowledgements: None.
Purpose: To identify and compare the reliability, validity and diagnostic accuracy of different assessments and imaging diagnostics of leg length discrepancy.
Methods: A review of diagnostic studies and reviews was conducted following systematic searches of MEDLINE (PubMed) and INDEX TO CHIROPRACTIC LITERATURE. Studies considered for analysis were selected using the recommendations of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Full-text studies and reviews regarding clinical assessments and imaging diagnostics for the diagnosis of leg length discrepancy which reported the clinimetric properties for assessment of leg length discrepancy were included and screened by two independent reviewers for methodological quality. Further inclusion criteria were English or German language and for studies dealing with clinical assessments a year of publication ≥1983 and for studies regarding imaging diagnostics a year of publication ≥2000 to provide a review of the updated literature. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was completed to evaluate the quality of the diagnostic studies. Thereby, the included studies were categorized as having a “high,” “moderate,” or “low” overall risk of bias or concerns regarding applicability.
Results: The search in PubMed identified 3716 studies and the search in INDEX TO CHIROPRACTIC LITERATURE resulted in 248 studies. After duplicates were removed (n=5), 30 articles on clinical assessments (25 studies; 5 reviews) and 10 studies on imaging diagnostics (9 studies; 1 review) met the eligibility criteria and were finally analyzed. Eight diagnostic studies on clinical assessments and 6 studies of imaging diagnostics had a low risk of bias and low concerns regarding applicability for all domains. For the clinical assessments, the block test showed a higher reliability, sensitivity, and specificity compared with using a tape measure. Leg length measurements in prone and supine positions as well as using devices, such as the PALpation Meter or the pelvic leveling device, demonstrated good reliability as well, however, for the latter two validity was only moderate as compared with imaging diagnostics. For the imaging diagnostics, it was shown, that a teleroentgenogram and a computed tomography scanogram are to be preferred for the initial examination of leg length discrepancy. Reliability of the EOSTM imaging system and pelvic radiography was excellent, however, validity was moderate for the latter. A laser-based ultrasonography had excellent reliability and correlated with a radiographic measurement.
Conclusion(s): For the clinical assessment of leg length discrepancy, the block test appears to be the most useful method followed by using a tape measure. The teleroentgenogram is considered the most convenient method of imaging diagnostics for initial examination. The EOSTM imaging can be recommended for follow-up examinations.
Implications: These findings may have relevance for the selection of clinical assessments to determine leg length discrepancy in clinical practice.
Keywords: Leg length discrepancy, measurement, review
Funding acknowledgements: None.
Topic: Musculoskeletal: lower limb; Orthopaedics; Musculoskeletal
Ethics approval required: No
Institution: Not applicable.
Ethics committee: Not applicable.
Reason not required: Ethics approval was not required for this review.
All authors, affiliations and abstracts have been published as submitted.
