Clinical examination findings as prognostic factors in low back pain: a systematic review of the literature
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CHIROPRACTIC & MANUAL THERAPIES
REVIEW
Open Access
Clinical examination findings as prognostic factors in low back pain: a systematic review of the literature Lisbeth Hartvigsen1*, Alice Kongsted1,2 and Lise Hestbaek1,2
Abstract Background: There is a strong tradition of performing a clinical examination of low back pain (LBP) patients and this is generally recommended in guidelines. However, establishing a pathoanatomic diagnosis does not seem possible in most LBP patients and clinical tests may potentially be more relevant as prognostic factors. The aim of this review of the literature was to systematically assess the association between low-tech clinical tests commonly used in adult patients with acute, recurrent or chronic LBP and short- and long-term outcome. Methods: MEDLINE, Embase, and MANTIS were searched from inception to June 2012. Prospective clinical studies of adult patients with LBP with or without leg pain and/or signs of nerve root involvement or spinal stenosis, receiving non-surgical or no treatment, which investigated the association between low-tech clinical tests and outcome were included. Study selection, data extraction and appraisal of study quality were performed independently by two reviewers. Results: A total of 5,332 citations were retrieved and screened for eligibility, 342 articles were assessed as full text and 49 met the inclusion criteria. Due to clinical and statistical heterogeneity, qualitative synthesis rather than meta-analysis was performed. Associations between clinical tests and outcomes were often inconsistent between studies. In more than one third of the tests, there was no evidence of the tests being associated with outcome. Only two clinical tests demonstrated a consistent association with at least one of the outcomes: centralization and non-organic signs. Conclusions: For most clinical tests in LBP there is not consistent evidence for an association with outcome. Centralization and non-organic signs are exceptions from that. None of the other clinical tests have been investigated in confirmatory studies and study quality is generally low. There is a need for hypothesis testing studies designed specifically to investigate the prognostic value of the clinical tests, and a need for standardization of the performance and interpretation of tests.
Background Low back pain (LBP) is a leading cause of disability worldwide, contributing to approximately 10% of all years lived with disability [1]. It is estimated that 632 million people are affected worldwide [1] and 12-33% of adults have LBP at any given time [2]. For some, acute episodes of pain subside within days or weeks but many experience more persistent pain and recurrences are common. About two-thirds of patients presenting in * Correspondence: [email protected] 1 Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark Full list of author information is available at the end of the article
primary care still report pain up to one year later or will have exper
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