On the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain in general practice. A criteria-based review of the literature

Abstract

Study design: A criteria-based review of the literature was conducted regarding the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain.

Objectives: To perform meta-analysis of the literature regarding signs and symptoms in diagnosing radiculopathy, ankylosing spondylitis, and vertebral cancer.

Summary of background data: Diagnosing low back pain, especially in general practice, depends largely on history taking, physical examination, and the erythrocyte sedimentation rate. No previous review has assessed the diagnostic accuracy of signs and symptoms in a systematic way, taking into account the methodological quality of studies.

Methods: The literature was reviewed for relevant studies. Retrieved studies were independently rated for methodological quality by two reviewers. The reported sensitivity and specificity in the rated studies were reviewed.

Results: Thirty-six eligible studies were retrieved. Major methodological shortcomings were observed, and only 19 studies scored > or = 55 points (maximal score 100). Not one single test appeared to have high sensitivity and high specificity in radiculopathy. The combined history and the erythrocyte sedimentation rate had relatively high diagnostic accuracy in vertebral cancer. Getting out of bed at night and reduced lateral mobility seemed to be the only moderately accurate items in ankylosing spondylitis.

Conclusions: Additional studies that take into account the shortcomings identified would be needed to produce definite conclusions. Few of the studied signs and symptoms seemed to be valuable diagnostics for radiculopathy, ankylosing spondylitis, and vertebral cancer. Reproducibility of signs and symptoms over time might be a valuable diagnostic criterion. However, this was neglected in almost all studies.