Manual Therapy

http://dx.doi.org/10.1016/j.math.2014.08.002

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 selfreport
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 þLR  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.

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