The reliability of palpatory examinations for pelvic landmarks to determine pelvic asymmetry: a systematic review and meta-analysis

Abstract Background Assessments and treatments focused on pelvic asymmetry are common amongst health professionals. However, there is no clear evidence for the reliability of palpatory examinations for pelvic landmarks. Objectives This review aimed to investigate the reliability of palpatory examinations for pelvic landmarks. Methods A systematic search was undertaken using eight databases from inceptions to 2021 January 8th, to identify relevant primary studies. Methodological quality of included studies was evaluated using quality appraisal tool for studies of diagnostic reliability (QAREL). Data on kappa statistics were synthesized quantitatively. Results 10 papers were included. Six papers had moderate methodological quality (50–70% in QAREL). Four pelvic landmarks, including anterior superior iliac spine, posterior superior iliac spine, sacral sulcus or inferior lateral angle were examined. For both inter-rater and intra-rater reliability, kappa statistics were consistently lower than 0.60 regardless of examiners’ qualifications or experience levels, or standardisation trainings. As a result of meta-analyses, pooled kappa statics were consistently lower than 0.06 for all landmarks. Conclusions Consistent evidence was found to suggest that palpatory examinations of pelvic landmarks to detect pelvic asymmetry do not have an acceptable reliability. Therefore, the current evidence does not support the use of these tests in clinical or educational settings.