Article type
Year
Abstract
Objective: To evaluate the sensitivity and specificity of history taking, physical examination, and erythrocyte sedimentation rate in low-back pain in general practice, for radiculopathy, vertebral cancer, and ankylosing spondylitis.
Methods: Review of the literature for studies presenting data on the issue. Independent rating of selected studies for methodological quality.
Results: 36 eligible studies were retrieved from the literature. From these 19 scored ? 60 points (maximal score 100). Major methodological shortcomings were observed regarding the technical quality of the index tests, reproducibility of both index and reference tests, and the selected study population. Straight Leg Raising, including the crossed versions, appear to be the most accurate tests in radiculopathy. An age over 50, sciatica and spinal tenderness in patients known to have cancer, and erythrocyte sedimentation rate ? 20 mm/hour appear to have a relative high accuracy vertebral cancer. Getting up from bed at night, and reduced lateral mobility seem to be the only moderately accurate items in ankylosing spondylitis. Data on the accuracy of combined signs and symptoms and the diagnostic value of following symptoms over time were lacking.
Discussion: History taking, physical examination, and erythrocyte sedimentation rate are only moderately accurate in diagnosing low-back pain in general practice. Future research, taking into account the observed shortcomings, is needed to establish their accuracy.
Methods: Review of the literature for studies presenting data on the issue. Independent rating of selected studies for methodological quality.
Results: 36 eligible studies were retrieved from the literature. From these 19 scored ? 60 points (maximal score 100). Major methodological shortcomings were observed regarding the technical quality of the index tests, reproducibility of both index and reference tests, and the selected study population. Straight Leg Raising, including the crossed versions, appear to be the most accurate tests in radiculopathy. An age over 50, sciatica and spinal tenderness in patients known to have cancer, and erythrocyte sedimentation rate ? 20 mm/hour appear to have a relative high accuracy vertebral cancer. Getting up from bed at night, and reduced lateral mobility seem to be the only moderately accurate items in ankylosing spondylitis. Data on the accuracy of combined signs and symptoms and the diagnostic value of following symptoms over time were lacking.
Discussion: History taking, physical examination, and erythrocyte sedimentation rate are only moderately accurate in diagnosing low-back pain in general practice. Future research, taking into account the observed shortcomings, is needed to establish their accuracy.