A systematic review and meta analysis of measurement properties for the flexion relaxation ratio in people with and without non specific spine pain
Abstract This review sought to identify, critically appraise, compare, and summarize the literature on the reliability, discriminative validity and responsiveness of the flexion relaxation ratio (FRR) in adults (≥ 18 years old) with or without spine pain (any duration), in either a clinical or resea...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2024-02-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-024-52900-z |
| _version_ | 1797274732097175552 |
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| author | Diana De Carvalho Sarah Mackey Daphne To Allyson Summers Mona Frey Kristen Romme Sheilah Hogg-Johnson Samuel J. Howarth |
| author_facet | Diana De Carvalho Sarah Mackey Daphne To Allyson Summers Mona Frey Kristen Romme Sheilah Hogg-Johnson Samuel J. Howarth |
| author_sort | Diana De Carvalho |
| collection | DOAJ |
| description | Abstract This review sought to identify, critically appraise, compare, and summarize the literature on the reliability, discriminative validity and responsiveness of the flexion relaxation ratio (FRR) in adults (≥ 18 years old) with or without spine pain (any duration), in either a clinical or research context. The review protocol was registered on Open Science Framework ( https://doi.org/10.17605/OSF.IO/27EDF ) and follows COSMIN, PRISMA, and PRESS guidelines. Six databases were searched from inception to June 1, 2022. The search string was developed by content experts and a health services librarian. Two pairs of reviewers independently completed titles/abstracts and full text screening for inclusion, data extraction, and risk of bias assessment (COSMIN RoB Toolkit). At all stages, discrepancies were resolved through consensus meetings. Data were pooled where possible with a three-level random effects meta-analyses and a modified GRADE assessment was used for the summary of findings. Following duplicate removal, 728 titles/abstracts and 219 full texts were screened with 23 included in this review. We found, with moderate certainty of evidence, that the cervical FRR has high test–retest reliability and lumbar FRR has moderate to high test–retest reliability, and with high certainty of evidence that the cervical and lumbar FRR can discriminate between healthy and clinical groups (standardized mean difference − 1.16 [95% CI − 2.00, − 0.32] and − 1.21 [− 1.84, − 0.58] respectively). There was not enough evidence to summarize findings for thoracic FRR discriminative validity or the standard error of measurement for the FRR. Several studies used FRR assuming responsiveness, but no studies were designed in a way that could confirm responsiveness. The evidence supports adequate reliability of FRR for the cervical and lumbar spine, and discriminative validity for the cervical and lumbar spine only. Improvements in study design and reporting are needed to strengthen the evidence base to determine the remaining measurement properties of this outcome. |
| first_indexed | 2024-03-07T15:03:29Z |
| format | Article |
| id | doaj.art-90a656b590f54e44ada4dc31c591468f |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-07T15:03:29Z |
| publishDate | 2024-02-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-90a656b590f54e44ada4dc31c591468f2024-03-05T19:02:51ZengNature PortfolioScientific Reports2045-23222024-02-0114111510.1038/s41598-024-52900-zA systematic review and meta analysis of measurement properties for the flexion relaxation ratio in people with and without non specific spine painDiana De Carvalho0Sarah Mackey1Daphne To2Allyson Summers3Mona Frey4Kristen Romme5Sheilah Hogg-Johnson6Samuel J. Howarth7Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of NewfoundlandDivision of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of NewfoundlandDepartment of Clinical Education, Canadian Memorial Chiropractic CollegeDivision of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of NewfoundlandDivision of BioMedical Sciences, Faculty of Medicine, Memorial University of NewfoundlandHealth Sciences Library, Faculty of Medicine, Memorial University of NewfoundlandDivision of Research and Innovation, Canadian Memorial Chiropractic CollegeDivision of Research and Innovation, Canadian Memorial Chiropractic CollegeAbstract This review sought to identify, critically appraise, compare, and summarize the literature on the reliability, discriminative validity and responsiveness of the flexion relaxation ratio (FRR) in adults (≥ 18 years old) with or without spine pain (any duration), in either a clinical or research context. The review protocol was registered on Open Science Framework ( https://doi.org/10.17605/OSF.IO/27EDF ) and follows COSMIN, PRISMA, and PRESS guidelines. Six databases were searched from inception to June 1, 2022. The search string was developed by content experts and a health services librarian. Two pairs of reviewers independently completed titles/abstracts and full text screening for inclusion, data extraction, and risk of bias assessment (COSMIN RoB Toolkit). At all stages, discrepancies were resolved through consensus meetings. Data were pooled where possible with a three-level random effects meta-analyses and a modified GRADE assessment was used for the summary of findings. Following duplicate removal, 728 titles/abstracts and 219 full texts were screened with 23 included in this review. We found, with moderate certainty of evidence, that the cervical FRR has high test–retest reliability and lumbar FRR has moderate to high test–retest reliability, and with high certainty of evidence that the cervical and lumbar FRR can discriminate between healthy and clinical groups (standardized mean difference − 1.16 [95% CI − 2.00, − 0.32] and − 1.21 [− 1.84, − 0.58] respectively). There was not enough evidence to summarize findings for thoracic FRR discriminative validity or the standard error of measurement for the FRR. Several studies used FRR assuming responsiveness, but no studies were designed in a way that could confirm responsiveness. The evidence supports adequate reliability of FRR for the cervical and lumbar spine, and discriminative validity for the cervical and lumbar spine only. Improvements in study design and reporting are needed to strengthen the evidence base to determine the remaining measurement properties of this outcome.https://doi.org/10.1038/s41598-024-52900-z |
| spellingShingle | Diana De Carvalho Sarah Mackey Daphne To Allyson Summers Mona Frey Kristen Romme Sheilah Hogg-Johnson Samuel J. Howarth A systematic review and meta analysis of measurement properties for the flexion relaxation ratio in people with and without non specific spine pain Scientific Reports |
| title | A systematic review and meta analysis of measurement properties for the flexion relaxation ratio in people with and without non specific spine pain |
| title_full | A systematic review and meta analysis of measurement properties for the flexion relaxation ratio in people with and without non specific spine pain |
| title_fullStr | A systematic review and meta analysis of measurement properties for the flexion relaxation ratio in people with and without non specific spine pain |
| title_full_unstemmed | A systematic review and meta analysis of measurement properties for the flexion relaxation ratio in people with and without non specific spine pain |
| title_short | A systematic review and meta analysis of measurement properties for the flexion relaxation ratio in people with and without non specific spine pain |
| title_sort | systematic review and meta analysis of measurement properties for the flexion relaxation ratio in people with and without non specific spine pain |
| url | https://doi.org/10.1038/s41598-024-52900-z |
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