A diagnostic tool for people with lumbar instability: a criterion-related validity study
Abstract Background Several clinical tests used to identify patients with lumbar instability have reported diagnostic accuracy in separate studies with conflicting results. To augment the diagnostic process, tests that are better able to identify lumbar instability suitable for use in the clinical s...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-11-01
|
| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-021-04854-w |
| _version_ | 1819126997315485696 |
|---|---|
| author | Thiwaphon Chatprem Rungthip Puntumetakul Jaturat Kanpittaya James Selfe Gillian Yeowell |
| author_facet | Thiwaphon Chatprem Rungthip Puntumetakul Jaturat Kanpittaya James Selfe Gillian Yeowell |
| author_sort | Thiwaphon Chatprem |
| collection | DOAJ |
| description | Abstract Background Several clinical tests used to identify patients with lumbar instability have reported diagnostic accuracy in separate studies with conflicting results. To augment the diagnostic process, tests that are better able to identify lumbar instability suitable for use in the clinical setting are required. The aim of this study was to identify the probability to diagnose patients with lumbar instability, using x-ray imaging as the reference standard. Methods This study was a cross-sectional, diagnostic validity study. One hundred forty participants with chronic low back pain underwent an x-ray assessment and 14 clinical examinations. Data were analysed using multivariate regression methods to determine which clinical tests were most diagnostic for lumbar instability when they were applied together. Results Eighteen (12.85%) participants had radiological lumbar instability. Three clinical tests i) interspinous gap change during flexion-extension, ii) passive accessory intervertebral movement tests, iii) posterior shear test demonstrated an ability to diagnose lumbar instability of 67% when they were all positive. At this probability threshold, sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (−LR) were 5.56, 99.18%, 6.78, and 0.95. Conclusions These 3 clinical tests could be useful in identifying patients with lumbar instability in the general community. These three tests are simple to perform by physical therapists, reliable to use in a clinical setting, and safe for patients. We recommend physical therapists use these three tests to assess patients who are suspected of having lumbar instability, in the absence of an x-ray assessment, to receive appropriate targeted intervention or referral for further investigation. Trial registration Thai Clinial Trial Registry (TCTR 20180820001; 19th August 2018). |
| first_indexed | 2024-12-22T08:04:55Z |
| format | Article |
| id | doaj.art-ba817caaee074e0d83161191a9d48551 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-22T08:04:55Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-ba817caaee074e0d83161191a9d485512022-12-21T18:33:10ZengBMCBMC Musculoskeletal Disorders1471-24742021-11-0122111010.1186/s12891-021-04854-wA diagnostic tool for people with lumbar instability: a criterion-related validity studyThiwaphon Chatprem0Rungthip Puntumetakul1Jaturat Kanpittaya2James Selfe3Gillian Yeowell4Faculty of Associated Medical Sciences, Khon Kaen UniversityResearch Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen UniversityDepartment of Radiology, Faculty of Medicine, Khon Kaen UniversityDepartment of Health Professions, Faculty of Health and Education, Manchester Metropolitan UniversityDepartment of Health Professions, Faculty of Health and Education, Manchester Metropolitan UniversityAbstract Background Several clinical tests used to identify patients with lumbar instability have reported diagnostic accuracy in separate studies with conflicting results. To augment the diagnostic process, tests that are better able to identify lumbar instability suitable for use in the clinical setting are required. The aim of this study was to identify the probability to diagnose patients with lumbar instability, using x-ray imaging as the reference standard. Methods This study was a cross-sectional, diagnostic validity study. One hundred forty participants with chronic low back pain underwent an x-ray assessment and 14 clinical examinations. Data were analysed using multivariate regression methods to determine which clinical tests were most diagnostic for lumbar instability when they were applied together. Results Eighteen (12.85%) participants had radiological lumbar instability. Three clinical tests i) interspinous gap change during flexion-extension, ii) passive accessory intervertebral movement tests, iii) posterior shear test demonstrated an ability to diagnose lumbar instability of 67% when they were all positive. At this probability threshold, sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (−LR) were 5.56, 99.18%, 6.78, and 0.95. Conclusions These 3 clinical tests could be useful in identifying patients with lumbar instability in the general community. These three tests are simple to perform by physical therapists, reliable to use in a clinical setting, and safe for patients. We recommend physical therapists use these three tests to assess patients who are suspected of having lumbar instability, in the absence of an x-ray assessment, to receive appropriate targeted intervention or referral for further investigation. Trial registration Thai Clinial Trial Registry (TCTR 20180820001; 19th August 2018).https://doi.org/10.1186/s12891-021-04854-wInstability testDiagnosticX-ray examination |
| spellingShingle | Thiwaphon Chatprem Rungthip Puntumetakul Jaturat Kanpittaya James Selfe Gillian Yeowell A diagnostic tool for people with lumbar instability: a criterion-related validity study BMC Musculoskeletal Disorders Instability test Diagnostic X-ray examination |
| title | A diagnostic tool for people with lumbar instability: a criterion-related validity study |
| title_full | A diagnostic tool for people with lumbar instability: a criterion-related validity study |
| title_fullStr | A diagnostic tool for people with lumbar instability: a criterion-related validity study |
| title_full_unstemmed | A diagnostic tool for people with lumbar instability: a criterion-related validity study |
| title_short | A diagnostic tool for people with lumbar instability: a criterion-related validity study |
| title_sort | diagnostic tool for people with lumbar instability a criterion related validity study |
| topic | Instability test Diagnostic X-ray examination |
| url | https://doi.org/10.1186/s12891-021-04854-w |
| work_keys_str_mv | AT thiwaphonchatprem adiagnostictoolforpeoplewithlumbarinstabilityacriterionrelatedvaliditystudy AT rungthippuntumetakul adiagnostictoolforpeoplewithlumbarinstabilityacriterionrelatedvaliditystudy AT jaturatkanpittaya adiagnostictoolforpeoplewithlumbarinstabilityacriterionrelatedvaliditystudy AT jamesselfe adiagnostictoolforpeoplewithlumbarinstabilityacriterionrelatedvaliditystudy AT gillianyeowell adiagnostictoolforpeoplewithlumbarinstabilityacriterionrelatedvaliditystudy AT thiwaphonchatprem diagnostictoolforpeoplewithlumbarinstabilityacriterionrelatedvaliditystudy AT rungthippuntumetakul diagnostictoolforpeoplewithlumbarinstabilityacriterionrelatedvaliditystudy AT jaturatkanpittaya diagnostictoolforpeoplewithlumbarinstabilityacriterionrelatedvaliditystudy AT jamesselfe diagnostictoolforpeoplewithlumbarinstabilityacriterionrelatedvaliditystudy AT gillianyeowell diagnostictoolforpeoplewithlumbarinstabilityacriterionrelatedvaliditystudy |