Infrared thermography and musculoskeletal injuries: A systematic review with meta-analysis

Background: The usage of thermal imaging for the diagnosis of musculoskeletal injuries has been demonstrated in which several diagnostic accuracy studies. Objective: This paper aimed to evaluate the effectiveness of infrared thermal imaging in detecting musculoskeletal injuries. Method: A systematic literature search was carried out in August 2019 in MEDLINE, LILACS, SCOPUS, SPORTDiscus, Cochrane, Scopus, Science Direct, CINAHL and Web of Science databases. The MeSH and DeCS descriptors used were "Thermography" and "Injury" with their synonyms (nine and sixteen, respectively) to find studies that followed the PIRT strategy: participants (non-elderly); index test (thermography); reference test (xray, arthroscopy, ultrasound, magnetic resonance imaging or computed tomography) and target condition (musculoskeletal injuries). The following data were extracted from the studies: author/year; the profile of the sample, the type and location of the injury, the thermographic protocol of evaluation, the acclimatization time, the reference standard, that statistical method used and if the study provided the data of the 2x2 table. Sensitivity, specificity, positive and negative likelihood ratios (LR + and LR-, respectively), odds ratios (OR) and the area under the receiver operating characteristic curve (SROC) were calculated and the DerSimonian Laird Method (random-effect model). The Begg Test was used to quantitatively analyze the publication bias. Results: A total of 2,947 studies were retrieved from the databases and nine were selected (six for the quantitative analysis). The meta-analysis showed that thermography presented a sensitivity of 0.70 (95%CI = 0.63-0.76); specificity of 0.75 (95% CI = 0.69-0.81); LR + of 2.45 (95%CI = 1.18-5.06); LRof 0.34 (95%CI = 0.14-0.83); OR = 7.54 (95%CI = 1.70-34.28); and SROC = 0.81 to detect musculoskeletal injuries. Conclusion: Infrared thermal imaging had a good diagnostic value for musculoskeletal injuries.