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Doody's Review ServiceReviewer: Dana J Lawrence, DC, MMedEd, MA (Palmer College of Chiropractic)
Description: This book is an overview of regional orthopedic tests commonly used in practice, providing clinical information on how to conduct and interpret the tests. This fifth edition also provides access to a website with video clips of procedures, offering additional practical, how-to information. This is a much-needed update to the 2003 edition.
Purpose: The purpose is to harmonize the mechanics of conducting each of the tests to ensure consistency. This will help remove some of the confusion that might otherwise arise when there is a lack of an authoritative source for how tests should be performed. Further, the online video clips support the text nicely. To that end, the book does provide comprehensive coverage of orthopedic tests in a clear and concise fashion.
Audience: The book is written by a chiropractor and has found its main home in the chiropractic profession, where it serves as a teaching text as well as an office reference. However, it also will find a home in the classroom or offices of other practitioners of manual therapy and orthopedic examination, such as physical therapists, physiatrists, and osteopaths. It serves well as a teaching manual. Dr. Cipriano is well known among chiropractic orthopedists, but perhaps not as well known among the general rank of chiropractic academics.
Features: This edition is not significantly different from earlier versions. What is new are the video clips — a truly nice touch — as well as a shift to the use of what the author refers to as the "Best Practice Utility Scale (BPUS)" (adapted from a past "sensitivity/reliability" scale), which is an indication of how useful a test is. The book begins with a short section on reliability and validity, important concepts in diagnostic testing, but I don't think this is clearly presented. For example, sensitivity is defined as "the ability of a test to identify the disease or injury" when it should more correctly be defined as "the ability of a test to correctly identify people who have the target disorder." It is then also identified as being equal to true positive plus false negative; in actuality, it is the ratio of true positive to true positive plus false negative [A/(A+C)]. The same mistake is made with regard to specificity. Notably, the author never discusses either predictive values or, more importantly, likelihood ratios, which are the most useful factor for diagnostic tests and which are derived from sensitivity and specificity. Thus, the book is a compendium of tests for use in clinical settings, but it never delves into the actual research for any of the tests it reports. The BPUS may be of some help, but it is not clear how it is derived, and the references do not provide comprehensive coverage of each test. This is a working manual, then. As a working manual, it is comprehensive and easy to use. It is amply illustrated and easy to follow, and it covers all areas.
Assessment: As a manual for either teaching the mechanics of these tests or for in-office use, this is a fine book. I think it would benefit from providing more detail on the actual sensitivity and specificity of its tests, allowing readers to generate likelihood ratios which can be used in practice and which help convert pre-test probabilities to post-test ones. One great addition to this book is access to the online video clips demonstrating procedures. But in terms of best practice approaches, providing the reader with more references would be a great help in the next edition.