Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Abstract

BackgroundClinical 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.MethodsA 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.ResultsSixty-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.ConclusionsThis 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1549-6) contains supplementary material, which is available to authorized users.

Diagnostics, treatment, rehabilitation and prevention of vertebral syndromes caused by traumatic elements

“…Рентгенологічні, магнітно-резонансні (МРТ) та інші методи візуальної діагностики, за даними літератури, не завжди корелюють зі ступенем клінічних проявів [1,2]. Вертеброгенні симптоми та синдроми можуть бути пов'язані з ураженням сегментарних нервових, судинних структур, а також зв'язкового та суглобового апарату, що ускладнює діагностику, лікування, реабілітацію [3], особливо при коморбідній патології [5,6,7,9,10,11,12]. Саме тому нами запропоновано термін "травмуючі елементи" [4], який означає всю сукупність патоморфологічних змін у сегментах хребта, які виникають внаслідок пошкодження або розвиваються при захворюваннях хребта і за своїми розмірами та напрямком є такими, що призводять до подразнення, часткової або повної компресії сегментарних нервових та/або судинних структур.…”

Role of a muscle factor in the development of low back pain

“…Коэф-фициент отношения правдоподобия, показывающий чувст-вительность и специфичность клинических тестов при МФБС, вообще не определен [17]. МФБС следует рассмат-ривать скорее как диагноз исключения, если не определя-ются другие доказанные источники боли [18].…”

Effect of muscle energy technique on pain pressure threshold in sacroiliac joint dysfunction

“…Tenderness present around the PSIS is considered to be a vital sign in the diagnosis of SIJD (Forst, 2006;Leeuwen, 2016). A recent clinical diagnostic rule suggested to examine the tenderness around the PSIS and incorporate it in the assessment of SIJD along with the pain provocation tests (Petersen et al, 2017). Therefore, it is imperative to ind out the effect of MET around the PSIS.…”