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Meta-analysis of the Sensitivity and Specificity of Platform Posturography

Meta-analysis of the Sensitivity and Specificity of Platform Posturography Abstract Objective: To compare the sensitivity and specificity of platform posturography with other vestibular tests for patients with peripheral vestibular deficits (PVD), Meniere's disease, benign paroxysmal positional vertigo (BPPV), and central nervous system-vestibular impairment (CNS). Data Sources: A computed search was conducted using the Index Medicus database (1966-1994) and Current Contents Science Editions. Study Selection: Studies were selected for analysis if the article addressed the sensitivity and/or specificity of platform posturography, compared posturography with another objective test of vestibular function, identified the basis for abnormal test results, and reported the data with sufficient detail to calculate an effect size from a 2×2 contingency table. Data Extraction: A count of the normal and abnormal test results for posturography and the criterion standard were retrieved from each article, analyzed using a x2 statistic, and converted to an effect size. A positive effect size indicated that posturography identified abnormalities in patients who had normal tests on the criterion standard. Data Synthesis: Sensitivity and specificity of posturography were about 50%. The overall effect size was small (0.13) but positive. The diagnostic category had a significant influence on the predictive value of abnormal results (73% for Meniere's disease and BPPV, compared with 41% for PVD, and 44% for mixed CNS and PVD (F2,12=5.26, P=.02) and on the magnitude of the effect size (0.41 for mixed CNS and PVD compared with 0.22 for Meniere's disease and BPPV, and −0.10 for PVD (F2,12=13.95, P=.001). Conclusions: Platform posturography provides a measurable supplement to the standard vestibular examination. The enhancement was most notable when the target population included patients with CNS deficits.(Arch Otolaryngol Head Neck Surg. 1996;122:150-156) References 1. Asai M, Watanabe Y, Ohashi N, Mizukoshi K. Evaluation of vestibular function by dynamic posturography and other equilibrium examinations . Acta Otolaryngol Suppl (Stockh) . 1993;504:120-124.Crossref 2. Keim RJ. Clinical comparisons of posturography and electronystagmography . Laryngoscope . 1993;103:713-716.Crossref 3. Black FO. Vestibular function assessment in patients with Meniere's disease: the vestibulospinal system . Laryngoscope . 1982;92:1419-1436. 4. Black FO, Shupert CL, Peterka RJ, Nashner LM. Effects of unilateral loss of vestibular function on the vestibulo-ocular reflex and postural control . Ann Otol Rhinol Laryngol . 1989;98:884-889. 5. Mirka A, Black FO. Clinical application of dynamic posturography for evaluating sensory integration and vestibular dysfunction . Neurol Clin . 1990;8:351-359. 6. Voorhees RL. The role of dynamic posturography in neurotologic diagnosis . Laryngoscope . 1989;99:995-1001.Crossref 7. Norre ME, Forrez G, Beckers A. Vestibular habituation training and posturography in benign paroxysmal positioning vertigo . ORL J Otorhinolaryngol Rel Spec . 1987;49:22-25.Crossref 8. Norre ME, Forrez G, Beckers A. Posturographic findings in two common peripheral vestibular disorders . J Otolaryngol . 1987;16:340-344. 9. Wall C III, Black FO. Postural stability and rotational tests: their effectiveness for screening dizzy patients . Acta Otolaryngol (Stockh) . 1983;95:235-246.Crossref 10. Black FO, Wall C III. Comparison of vestibulo-ocular and vestibulospinal screening tests . Otolaryngol Head Neck Surg . 1981;89:811-817. 11. Norre ME, Forrez G, Beckers A. Benign paroxysmal positional vertigo: clinical observations by vestibular habituation training and by posturography . J Laryngol Otol . 1987;101:443-447.Crossref 12. Norre ME, Forrez G. Vestibulospinal function in otoneurology . ORL J Otorhinolaryngol Rel Spec . 1986;48:37-44.Crossref 13. Black FO, Wall C III, Nashner LM. Effects of visual and support surface orientation references upon postural control in vestibular deficient subjects . Acta Otolaryngol (Stockh) . 1983;95:199-210.Crossref 14. Nashner LM, Black FO, Wall C III. Adaptation to altered support and visual conditions during stance: patients with vestibular deficits . J Neurosci . 1982;2:536-544. 15. Nashner LM, Peters JF. Dynamic posturography in the diagnosis and management of dizziness and balance disorders . Neurol Clin . 1990;8:331-349. 16. Shepard NT, Schultz A, Alexander NB, Ju Gu M, Boismeir TB. Postural control in young and elderly adults when stance is challenged: clinical versus laboratory measurements . Ann Otol Rhinol Otolaryngol . 1993;102:508-517. 17. Stockwell CW. Vestibular function testing: 4-year update . In: Cummings C, ed. Otolaryngology Head and Neck Surgery, Update II . St Louis, Mo: Mosby–Yearbook; 1990:39-53. 18. Parker SW. Vestibular evaluation: electronystagmography, rotational testing, and posturography . Clin Electroencephalogr . 1993;24:151-159.Crossref 19. Hamid MA, Hughes GB, Kinney SE. Specificity and sensitivity of dynamic posturography; a retrospective analysis . Acta Otolaryngol Suppl (Stockh) . 1991; 481:596-600.Crossref 20. Voorhees RL. Dynamic posturography findings in central nervous system disorders . Otolaryngol Head Neck Surg . 1990;103:96-101. 21. Norre ME, Forrez GHJ, Beckers AM. Vestibular compensation evaluated by rotation tests and posturography . Arch Otolaryngol Head Neck Surg . 1987;113: 533-535.Crossref 22. Norre ME. Sensory interaction posturography in patients with benign paroxysmal positional vertigo . Clin Otolaryngol . 1993;18:226-230.Crossref 23. Glossary of methodologic terms . Arch Otolaryngol Head Neck Surg . 1994;120:15. 24. Weber PC, Cass SP. Clinical assessment of postural stability . Am J Otol . 1993; 14:566-569. 25. Horstmann GA, Dietz V. The contribution of vestibular input to the stabilization of human posture: a new experimental approach . Neurosci Lett . 1988;95:179-184.Crossref 26. Deitz V, Horstmann GA, Berger W. Fast head tilt has only a minor effect on quick compensatory reactions during the regulation of stance and gait . Exp Brain Res . 1988;73:470-476.Crossref 27. Dichgans J, Diener HC. The contribution of vestibulospinal mechanisms to the maintenance of human upright posture . Acta Otolaryngol (Stockh) . 1989;107:338-345.Crossref 28. Di Fabio RP. Sensitivity and specificity of platform posturography for identifying patients with vestibular dysfunction . Phys Ther . 1995;75:290-305. 29. Glass GV, McGaw B, Smith ML. Meta-Analysis in Social Research . Beverly Hills, Calif: Sage Publications; 1987. 30. Sacks HS, Berrier J, Reitman D, Ancona-Berk VA, Chalmers TC. Meta-analysis of randomized controlled trials . N Engl J Med . 1987;316:450-455.Crossref 31. Boissel JP, Blanchard J, Panak E, Peyrieus JC, Sacks H. Considerations for the meta-analysis of randomized clinical trials . Control Clin Trials . 1989;10:254-281.Crossref 32. Light RJ. Accumulating evidence from independent studies: what we can win and what we can lose . Stat Med . 1987;6:221-228.Crossref 33. Cooper HM. Scientific guidelines for conducting integrative research reviews . Rev Educ Res . 1982;52:291-302.Crossref 34. Goebel JA, Paige GD. Dynamic posturography and caloric test results in patients with and without vertigo . Otolaryngol Head Neck Surg . 1989;100:553-558. 35. Norre ME, Forrez G, Beckers A. Clinical application of vestibulospinal reflex tests in peripheral vestibular disorders . Acta Otolaryngol (Stockh) . 1989;468:337-339.Crossref 36. Norre ME, Forrez G, Beckers A. Vestibulospinal findings in two syndromes with spontaneous vertigo attacks . Ann Otol Rhinol Laryngol . 1989;98:191-195. 37. Norre ME, Forrez G, Beckers A. Vestibular dysfunction causing instability in aged patients . Acta Otolaryngol (Stockh) . 1987;104:50-55.Crossref 38. Norre ME, Forrez G, Beckers A. Posturography measuring instability in vestibular dysfunction in the elderly . Age Ageing . 1987;16:89-93.Crossref 39. Norre ME, Forrez G, Beckers A. Vestibulospinal function in two syndromes with spontaneous attacks of vertigo: evaluation by posturography . Clin Otolaryngol . 1987;12:215-220.Crossref 40. Cohen J. Statistical Power Analysis for the Behavioral Sciences . Hillsdale, NJ: Lawrence Erlbaum Associates Inc Publishers; 1987:215-271. 41. BMDP Statistical Software Manual: Volume 1 . Berkeley, Calif: University of California Press; 1992:273. 42. Friedman H. Magnitude of experimental effect and a table for its rapid estimation . Psychol Bull . 1968;70:245-251.Crossref 43. Herdman SJ, Tusa RJ, Zee DS, Proctor L, Mattox DE. Single treatment approaches to benign paroxysmal positional vertigo . Arch Otolaryngol Head Neck Surg . 1993:119:450-454. 44. Jacobson GP, Newman CW, Hunter L, Balzer GK. Balance function test correlates of the Dizziness Handicap Inventory . J Am Acad Audiol . 1991;2:253-260. 45. Black FO. Equilibrium . Otolaryngol Head Neck Surg . 1992;106:16-18. Editorial. 46. Rosenthal R. Combining results of independent studies . Psychol Bull . 1978; 85:185-193.Crossref 47. Barin K, Seitz CM, Welling DB. Effect of head orientation on the diagnostic sensitivity of posturography in patients with compensated unilateral lesions . Otolaryngol Head Neck Surg . 1992;106:355-362. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Meta-analysis of the Sensitivity and Specificity of Platform Posturography

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1996.01890140036008
Publisher site
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Abstract

Abstract Objective: To compare the sensitivity and specificity of platform posturography with other vestibular tests for patients with peripheral vestibular deficits (PVD), Meniere's disease, benign paroxysmal positional vertigo (BPPV), and central nervous system-vestibular impairment (CNS). Data Sources: A computed search was conducted using the Index Medicus database (1966-1994) and Current Contents Science Editions. Study Selection: Studies were selected for analysis if the article addressed the sensitivity and/or specificity of platform posturography, compared posturography with another objective test of vestibular function, identified the basis for abnormal test results, and reported the data with sufficient detail to calculate an effect size from a 2×2 contingency table. Data Extraction: A count of the normal and abnormal test results for posturography and the criterion standard were retrieved from each article, analyzed using a x2 statistic, and converted to an effect size. A positive effect size indicated that posturography identified abnormalities in patients who had normal tests on the criterion standard. Data Synthesis: Sensitivity and specificity of posturography were about 50%. The overall effect size was small (0.13) but positive. The diagnostic category had a significant influence on the predictive value of abnormal results (73% for Meniere's disease and BPPV, compared with 41% for PVD, and 44% for mixed CNS and PVD (F2,12=5.26, P=.02) and on the magnitude of the effect size (0.41 for mixed CNS and PVD compared with 0.22 for Meniere's disease and BPPV, and −0.10 for PVD (F2,12=13.95, P=.001). Conclusions: Platform posturography provides a measurable supplement to the standard vestibular examination. The enhancement was most notable when the target population included patients with CNS deficits.(Arch Otolaryngol Head Neck Surg. 1996;122:150-156) References 1. Asai M, Watanabe Y, Ohashi N, Mizukoshi K. Evaluation of vestibular function by dynamic posturography and other equilibrium examinations . Acta Otolaryngol Suppl (Stockh) . 1993;504:120-124.Crossref 2. Keim RJ. Clinical comparisons of posturography and electronystagmography . Laryngoscope . 1993;103:713-716.Crossref 3. Black FO. Vestibular function assessment in patients with Meniere's disease: the vestibulospinal system . Laryngoscope . 1982;92:1419-1436. 4. Black FO, Shupert CL, Peterka RJ, Nashner LM. Effects of unilateral loss of vestibular function on the vestibulo-ocular reflex and postural control . Ann Otol Rhinol Laryngol . 1989;98:884-889. 5. Mirka A, Black FO. Clinical application of dynamic posturography for evaluating sensory integration and vestibular dysfunction . Neurol Clin . 1990;8:351-359. 6. Voorhees RL. The role of dynamic posturography in neurotologic diagnosis . Laryngoscope . 1989;99:995-1001.Crossref 7. Norre ME, Forrez G, Beckers A. Vestibular habituation training and posturography in benign paroxysmal positioning vertigo . ORL J Otorhinolaryngol Rel Spec . 1987;49:22-25.Crossref 8. Norre ME, Forrez G, Beckers A. Posturographic findings in two common peripheral vestibular disorders . J Otolaryngol . 1987;16:340-344. 9. Wall C III, Black FO. Postural stability and rotational tests: their effectiveness for screening dizzy patients . Acta Otolaryngol (Stockh) . 1983;95:235-246.Crossref 10. Black FO, Wall C III. Comparison of vestibulo-ocular and vestibulospinal screening tests . Otolaryngol Head Neck Surg . 1981;89:811-817. 11. Norre ME, Forrez G, Beckers A. Benign paroxysmal positional vertigo: clinical observations by vestibular habituation training and by posturography . J Laryngol Otol . 1987;101:443-447.Crossref 12. Norre ME, Forrez G. Vestibulospinal function in otoneurology . ORL J Otorhinolaryngol Rel Spec . 1986;48:37-44.Crossref 13. Black FO, Wall C III, Nashner LM. Effects of visual and support surface orientation references upon postural control in vestibular deficient subjects . Acta Otolaryngol (Stockh) . 1983;95:199-210.Crossref 14. Nashner LM, Black FO, Wall C III. Adaptation to altered support and visual conditions during stance: patients with vestibular deficits . J Neurosci . 1982;2:536-544. 15. Nashner LM, Peters JF. Dynamic posturography in the diagnosis and management of dizziness and balance disorders . Neurol Clin . 1990;8:331-349. 16. Shepard NT, Schultz A, Alexander NB, Ju Gu M, Boismeir TB. Postural control in young and elderly adults when stance is challenged: clinical versus laboratory measurements . Ann Otol Rhinol Otolaryngol . 1993;102:508-517. 17. Stockwell CW. Vestibular function testing: 4-year update . In: Cummings C, ed. Otolaryngology Head and Neck Surgery, Update II . St Louis, Mo: Mosby–Yearbook; 1990:39-53. 18. Parker SW. Vestibular evaluation: electronystagmography, rotational testing, and posturography . Clin Electroencephalogr . 1993;24:151-159.Crossref 19. Hamid MA, Hughes GB, Kinney SE. Specificity and sensitivity of dynamic posturography; a retrospective analysis . Acta Otolaryngol Suppl (Stockh) . 1991; 481:596-600.Crossref 20. Voorhees RL. Dynamic posturography findings in central nervous system disorders . Otolaryngol Head Neck Surg . 1990;103:96-101. 21. Norre ME, Forrez GHJ, Beckers AM. Vestibular compensation evaluated by rotation tests and posturography . Arch Otolaryngol Head Neck Surg . 1987;113: 533-535.Crossref 22. Norre ME. Sensory interaction posturography in patients with benign paroxysmal positional vertigo . Clin Otolaryngol . 1993;18:226-230.Crossref 23. Glossary of methodologic terms . Arch Otolaryngol Head Neck Surg . 1994;120:15. 24. Weber PC, Cass SP. Clinical assessment of postural stability . Am J Otol . 1993; 14:566-569. 25. Horstmann GA, Dietz V. The contribution of vestibular input to the stabilization of human posture: a new experimental approach . Neurosci Lett . 1988;95:179-184.Crossref 26. Deitz V, Horstmann GA, Berger W. Fast head tilt has only a minor effect on quick compensatory reactions during the regulation of stance and gait . Exp Brain Res . 1988;73:470-476.Crossref 27. Dichgans J, Diener HC. The contribution of vestibulospinal mechanisms to the maintenance of human upright posture . Acta Otolaryngol (Stockh) . 1989;107:338-345.Crossref 28. Di Fabio RP. Sensitivity and specificity of platform posturography for identifying patients with vestibular dysfunction . Phys Ther . 1995;75:290-305. 29. Glass GV, McGaw B, Smith ML. Meta-Analysis in Social Research . Beverly Hills, Calif: Sage Publications; 1987. 30. Sacks HS, Berrier J, Reitman D, Ancona-Berk VA, Chalmers TC. Meta-analysis of randomized controlled trials . N Engl J Med . 1987;316:450-455.Crossref 31. Boissel JP, Blanchard J, Panak E, Peyrieus JC, Sacks H. Considerations for the meta-analysis of randomized clinical trials . Control Clin Trials . 1989;10:254-281.Crossref 32. Light RJ. Accumulating evidence from independent studies: what we can win and what we can lose . Stat Med . 1987;6:221-228.Crossref 33. Cooper HM. Scientific guidelines for conducting integrative research reviews . Rev Educ Res . 1982;52:291-302.Crossref 34. Goebel JA, Paige GD. Dynamic posturography and caloric test results in patients with and without vertigo . Otolaryngol Head Neck Surg . 1989;100:553-558. 35. Norre ME, Forrez G, Beckers A. Clinical application of vestibulospinal reflex tests in peripheral vestibular disorders . Acta Otolaryngol (Stockh) . 1989;468:337-339.Crossref 36. Norre ME, Forrez G, Beckers A. Vestibulospinal findings in two syndromes with spontaneous vertigo attacks . Ann Otol Rhinol Laryngol . 1989;98:191-195. 37. Norre ME, Forrez G, Beckers A. Vestibular dysfunction causing instability in aged patients . Acta Otolaryngol (Stockh) . 1987;104:50-55.Crossref 38. Norre ME, Forrez G, Beckers A. Posturography measuring instability in vestibular dysfunction in the elderly . Age Ageing . 1987;16:89-93.Crossref 39. Norre ME, Forrez G, Beckers A. Vestibulospinal function in two syndromes with spontaneous attacks of vertigo: evaluation by posturography . Clin Otolaryngol . 1987;12:215-220.Crossref 40. Cohen J. Statistical Power Analysis for the Behavioral Sciences . Hillsdale, NJ: Lawrence Erlbaum Associates Inc Publishers; 1987:215-271. 41. BMDP Statistical Software Manual: Volume 1 . Berkeley, Calif: University of California Press; 1992:273. 42. Friedman H. Magnitude of experimental effect and a table for its rapid estimation . Psychol Bull . 1968;70:245-251.Crossref 43. Herdman SJ, Tusa RJ, Zee DS, Proctor L, Mattox DE. Single treatment approaches to benign paroxysmal positional vertigo . Arch Otolaryngol Head Neck Surg . 1993:119:450-454. 44. Jacobson GP, Newman CW, Hunter L, Balzer GK. Balance function test correlates of the Dizziness Handicap Inventory . J Am Acad Audiol . 1991;2:253-260. 45. Black FO. Equilibrium . Otolaryngol Head Neck Surg . 1992;106:16-18. Editorial. 46. Rosenthal R. Combining results of independent studies . Psychol Bull . 1978; 85:185-193.Crossref 47. Barin K, Seitz CM, Welling DB. Effect of head orientation on the diagnostic sensitivity of posturography in patients with compensated unilateral lesions . Otolaryngol Head Neck Surg . 1992;106:355-362.

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Feb 1, 1996

References

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