Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews
Abstract Background Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anat...
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| Format: | Article |
| Language: | English |
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BMC
2017-05-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | http://link.springer.com/article/10.1186/s12891-017-1549-6 |
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| author | Tom Petersen Mark Laslett Carsten Juhl |
| author_facet | Tom Petersen Mark Laslett Carsten Juhl |
| author_sort | Tom Petersen |
| collection | DOAJ |
| description | Abstract Background Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization. Methods A sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR. Results Sixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making. Conclusions This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed. |
| first_indexed | 2024-04-13T11:16:47Z |
| format | Article |
| id | doaj.art-94ed7164493d485a912ba2c147246178 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-13T11:16:47Z |
| publishDate | 2017-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-94ed7164493d485a912ba2c1472461782022-12-22T02:48:57ZengBMCBMC Musculoskeletal Disorders1471-24742017-05-0118112310.1186/s12891-017-1549-6Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviewsTom Petersen0Mark Laslett1Carsten Juhl2Back Center CopenhagenPhysioSouth LtdResearch Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern DenmarkAbstract Background Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization. Methods A sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR. Results Sixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making. Conclusions This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed.http://link.springer.com/article/10.1186/s12891-017-1549-6Diagnostic accuracySensitivity and specificityClinical examinationLow back pain classificationClinical decision making |
| spellingShingle | Tom Petersen Mark Laslett Carsten Juhl Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews BMC Musculoskeletal Disorders Diagnostic accuracy Sensitivity and specificity Clinical examination Low back pain classification Clinical decision making |
| title | Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews |
| title_full | Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews |
| title_fullStr | Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews |
| title_full_unstemmed | Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews |
| title_short | Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews |
| title_sort | clinical classification in low back pain best evidence diagnostic rules based on systematic reviews |
| topic | Diagnostic accuracy Sensitivity and specificity Clinical examination Low back pain classification Clinical decision making |
| url | http://link.springer.com/article/10.1186/s12891-017-1549-6 |
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