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dc.contributor.authorIversen, Trond
dc.contributor.authorSolberg, Tore
dc.contributor.authorRomner, Bertil
dc.contributor.authorWilsgaard, Tom
dc.contributor.authorNygaard, Øystein Petter
dc.contributor.authorWaterloo, Knut
dc.contributor.authorBrox, Jens Ivar
dc.contributor.authorIngebrigtsen, Tor
dc.date.accessioned2014-03-20T15:44:22Z
dc.date.available2014-03-20T15:44:22Z
dc.date.issued2013
dc.description.abstractBackground: Clinical examination of patients with chronic lumbar radiculopathy aims to clarify whether there is nerve root impingement. The aims of this study were to investigate the association between findings at clinical examination and nerve root impingement, to evaluate the accuracy of clinical index tests in a specialised care setting, and to see whether imaging clarifies the cause of chronic radicular pain. Methods: A total of 116 patients referred with symptoms of lumbar radiculopathy lasting more than 12 weeks and at least one positive index test were included. The tests were the straight leg raising test, and tests for motor muscle strength, dermatome sensory loss, and reflex impairment. Magnetic resonance imaging (n = 109) or computer tomography (n = 7) were imaging reference standards. Images were analysed at the level of single nerve root(s), and nerve root impingement was classified as present or absent. Sensitivities, specificities, and positive and negative likelihood ratios (LR) for detection of nerve root impingement were calculated for each individual index test. An overall clinical evaluation, concluding on the level and side of the radiculopathy, was performed. Results: The prevalence of disc herniation was 77.8%. The diagnostic accuracy of individual index tests was low with no tests reaching positive LR >4.0 or negative LR <0.4. The overall clinical evaluation was slightly more accurate, with a positive LR of 6.28 (95% CI 1.06–37.21) for L4, 1.74 (95% CI 1.04–2.93) for L5, and 1.29 (95% CI 0.97–1.72) for S1 nerve root impingement. An overall clinical evaluation, concluding on the level and side of the radiculopathy was also performed, and receiver operating characteristic (ROC) analysis with area under the curve (AUC) calculation for diagnostic accuracy of this evaluation was performed. Conclusions: The accuracy of individual clinical index tests used to predict imaging findings of nerve root impingement in patients with chronic lumbar radiculopathy is low when applied in specialised care, but clinicians’ overall evaluation improves diagnostic accuracy slightly. The tests are not very helpful in clarifying the cause of radicular pain, and are therefore inaccurate for guidance in the diagnostic workup of the patients. The study population was highly selected and therefore the results from this study should not be generalised to unselected patient populations in primary care nor to even more selected surgical populations.en
dc.identifier.citationBMC Musculoskeletal Disorders 14(2013) nr. 206 s. -en
dc.identifier.cristinIDFRIDAID 1089483
dc.identifier.doihttp://dx.doi.org/0.1186/1471-2474-14-206
dc.identifier.issn1471-2474
dc.identifier.urihttps://hdl.handle.net/10037/6027
dc.identifier.urnURN:NBN:no-uit_munin_5711
dc.language.isoengen
dc.publisherBioMed Centralen
dc.rights.accessRightsopenAccess
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Radiology and diagnostic imaging: 763en
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Radiologi og bildediagnostikk: 763en
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Physical medicine and rehabilitation: 764en
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Fysikalsk medisin og rehabilitering: 764en
dc.titleAccuracy of physical examination for chronic lumbar radiculopathyen
dc.typeJournal articleen
dc.typeTidsskriftartikkelen
dc.typePeer revieweden


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