Guidelines for pre-manipulative testing of the cervical spine - an appraisal

Are the guidelines valid? It is not clear if recommendations were derived from evidence of high quality or from evidence that is much more liable to error. The majority of evidence is based on low level evidence; that is, physiology, bench research, or "first principles" (Sackett et al 2000). Studies of moderate level evidence, where inappropriate sampling and a narrow spectrum of study individuals was used, revealed vertebrobasilar insufficiency tests to be invalid. Information on the validity of the diagnostic studies, their accuracy, and detailed instruction for applying that evidence to our patients (Sackett et al 2000) was not reported in the guidelines.