Elsevier

Manual Therapy

Volume 20, Issue 1, February 2015, Pages 18-27
Manual Therapy

Systematic review
Diagnostic accuracy of self-report and subjective history in the diagnosis of low back pain with non-specific lower extremity symptoms: A systematic review

https://doi.org/10.1016/j.math.2014.08.002Get rights and content

Abstract

Subjective history questions/self-report items are commonly used to triage the patient with low back pain and related leg symptoms. However the value of the history taking process for decision-making to identify common classifications/diagnosis for patients presenting with low back related leg pain (LBRLP) have not been considered. The purpose of this study was to investigate the diagnostic accuracy of self-report items/history-taking questions used to identify patients with LBRLP.

Eligible studies included: 1)subjects with low back pain AND related lower extremity pain, 2)details of subjective examination/self-report items, 3)cohort, prospective/longitudinal studies, and randomized control trials, 4)use of statistical reporting, 5)an acceptable reference standard. Quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2. A synthesis of history items that met the threshold for at least a small shift in the likelihood of the condition with a +LR ≥ 2 or −LR ≤ 0.5 were reported.

Conditions commonly reported in the literature: lumbar spinal stenosis, lumbosacral nerve root compression/radiculopathy, disc herniation and neurophysiological low back pain ± leg pain. Eleven studies met the inclusion criteria.

This is the first systematic review of diagnostic accuracy studies that examined only the history-taking items for their ability to identify LBRLP conditions. Clustering key items may provide a more precise clinical picture necessary to detect and treat a patient's presentation. History questions formed within the interview and their contributing value for decision-making remain understudied. There is a need for better designs to determine a more accurate diagnostic power to identify conditions with LBRLP.

Section snippets

Background

Low-back and low-back related leg pain complaints are frequently addressed by healthcare practitioners. These conditions can be seriously debilitating to patients and impose a significant social and economic burden on the community (Delitto et al., 2012). Accompanying leg pain is present in approximately 25–57% of all LBP cases (Shäfer et al., 2009). Low-back related leg pain with or without nerve root involvement is also associated with a poor prognosis compared to low back pain (LBP) alone (

Study design

A systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines for Reporting Systematic Reviews (Liberati et al., 2009). PRISMA is intended to improve the “transparency and scientific merit” of systematic reviews and meta-analyses using a 27-item checklist (Liberati et al., 2009). The PRISMA guidelines were followed and the 27-item checklist was completed in order to improve the reporting of this systematic review.

Selection of studies

The systematic search of relevant electronic databases and a comprehensive hand search resulted in a total of 517 articles (Fig. 1). After the duplicates were removed and further screened, we had a total of 38 full-text articles evaluated through a full-text screening, in which 26 studies were excluded for various reasons (Table 3). Resultantly, a total of 11 studies were included in this review. The inter-observer reliability of the study selection for title reviews, abstract reviews, and

Discussion

The purpose of this study was to examine the diagnostic accuracy of self-report items and subjective history questions used to identify underlying spinal conditions that commonly cause low back-related leg pain. This review evaluated 11 diagnostic studies that specifically assessed the diagnostic ability of the history questions from interview, questionnaire, and/or self-report to identify conditions commonly associated with low back related leg pain. The literature available most commonly

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