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...

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Autores principales:	Thiwaphon Chatprem, Rungthip Puntumetakul, Jaturat Kanpittaya, James Selfe, Gillian Yeowell
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Instability test Diagnostic X-ray examination Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/ba817caaee074e0d83161191a9d48551
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spelling	oai:doaj.org-article:ba817caaee074e0d83161191a9d485512021-11-28T12:24:38ZA diagnostic tool for people with lumbar instability: a criterion-related validity study10.1186/s12891-021-04854-w1471-2474https://doaj.org/article/ba817caaee074e0d83161191a9d485512021-11-01T00:00:00Zhttps://doi.org/10.1186/s12891-021-04854-whttps://doaj.org/toc/1471-2474Abstract 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).Thiwaphon ChatpremRungthip PuntumetakulJaturat KanpittayaJames SelfeGillian YeowellBMCarticleInstability testDiagnosticX-ray examinationDiseases of the musculoskeletal systemRC925-935ENBMC Musculoskeletal Disorders, Vol 22, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Instability test Diagnostic X-ray examination Diseases of the musculoskeletal system RC925-935
spellingShingle	Instability test Diagnostic X-ray examination Diseases of the musculoskeletal system RC925-935 Thiwaphon Chatprem Rungthip Puntumetakul Jaturat Kanpittaya James Selfe Gillian Yeowell A diagnostic tool for people with lumbar instability: a criterion-related validity study
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).
format	article
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
title	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_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_sort	diagnostic tool for people with lumbar instability: a criterion-related validity study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/ba817caaee074e0d83161191a9d48551
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A diagnostic tool for people with lumbar instability: a criterion-related validity study

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