Reliability and Diagnostic Accuracy of the Clinical Examination and Patient Self-Report Measures for Cervical Radiculopathy

Wainner, Robert S.; Fritz, Julie M.; Irrgang, James J.; Boninger, Michael L.; Delitto, Anthony; Allison, Stephen

doi:10.1097/00007632-200301010-00014

Cited by 485 publications

(418 citation statements)

References 45 publications

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“…Visual Analogue Scale (VAS) (Langley and Sheppeard, 1985, Breivik et al , 2000, Wainner et al , 2003: Patients were requested to indicate on a 100mm line the point that best represented their level of neck pain and dizziness.…”

Section: Subjective Measuresmentioning

confidence: 99%

Interactive cervical motion kinematics: Sensitivity, specificity and clinically significant values for identifying kinematic impairments in patients with chronic neck pain

et al. 2015

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Interactive cervical motion kinematics: sensitivity, specificity and clinically significant values for identifying kinematic impairments in patients with chronic neck pain. AbstractChronic neck pain has been consistently shown to be associated with impaired kinematic control including reduced range, velocity and smoothness of cervical motion, that seem relevant to daily function as in quick neck motion in response to surrounding stimuli. The objectives of this study were: to compare interactive cervical kinematics in patients with neck pain and controls; to explore the new measures of cervical motion accuracy; and to find the sensitivity, specificity, and optimal cutoff values for defining impaired kinematics in those with neck pain.In this cross-section study, 33 patients with chronic neck pain and 22 asymptomatic controls were assessed for their cervical kinematic control using interactive virtual reality hardware and customized software utilizing a head mounted display with built-in head tracking.Outcome measures included peak and mean velocity, smoothness (NVP), symmetry (TTPP), and accuracy of cervical motion.Results demonstrated significant and strong effect-size differences in peak and mean velocities, NVP and TTPP in all directions excluding TTPP in left rotation, and good effect-size group differences in 5/8 accuracy measures.Regression results emphasized the high clinical value of neck motion velocity, with very high sensitivity and specificity (85%-100%), followed by motion smoothness, symmetry and accuracy. These finding suggest cervical kinematics should be evaluated clinically, and screened by the provided cut off values for identification of relevant impairments in those with neck pain. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTSuch identification of presence or absence of kinematic impairments may direct treatment strategies and additional evaluation when needed.

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Section: Subjective Measuresmentioning

confidence: 99%

Interactive cervical motion kinematics: Sensitivity, specificity and clinically significant values for identifying kinematic impairments in patients with chronic neck pain

et al. 2015

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“…We excluded 354 studies on the basis of their titles and abstracts. We then retrieved and reviewed 12 full reports for possible inclusion [4,19,21,35,42,48,51,55,59,60,62,63]. Four studies were excluded because they examined either reliability or repeatability of the test, but not diagnostic accuracy [4,19,35,48].…”

Section: Data Synthesismentioning

confidence: 99%

“…Two studies were excluded because the tests were used to evaluate clinical conditions other than radiculopathy [55,60]. This resulted in six studies which fulfilled our inclusion criteria [21,42,51,59,62,63], all of which were found in MEDLINE. Subsequently, we searched PubMed and CINAHL for additional relevant articles, which resulted in 218 and 66 additional references, respectively, not found in the Embase.com search.…”

Section: Data Synthesismentioning

confidence: 99%

“…To that end, various clinical provocative tests have been proposed which purport to be diagnostic of cervical radiculopathy [4,42,46,59,62,63]. Examples of these tests include, but are not limited to the upper limb tension test [ULTT] (formerly called the brachial plexus tension test, or test of Elvey) [3,24,32,42,44,49,63], the shoulder abduction test (also known as the shoulder abduction relief sign) [21,25], and Spurling's test (also known as the foraminal compression test, neck compression test, or quadrant test) [36,54,59,60].…”

Section: Introductionmentioning

confidence: 99%

“…Examples of these tests include, but are not limited to the upper limb tension test [ULTT] (formerly called the brachial plexus tension test, or test of Elvey) [3,24,32,42,44,49,63], the shoulder abduction test (also known as the shoulder abduction relief sign) [21,25], and Spurling's test (also known as the foraminal compression test, neck compression test, or quadrant test) [36,54,59,60]. These tests are not meant to supplant the neurological examination, nor to ignore those subjects with clear neurological deficits.…”

Section: Introductionmentioning

confidence: 99%

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A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

et al. 2006

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Clinical provocative tests of the neck, which position the neck and arm inorder to aggravate or relieve arm symptoms, are commonly used in clinical practice in patients with a suspected cervical radiculopathy. Their diagnostic accuracy, however, has never been examined in a systematic review. A comprehensive search was conducted in order to identify all possible studies fulfilling the inclusion criteria. A study was included if: (1) any provocative test of the neck for diagnosing cervical radiculopathy was identified; (2) any reference standard was used; (3) sensitivity and specificity were reported or could be (re-)calculated; and, (4) the publication was a full report. Two reviewers independently selected studies, and assessed methodological quality. Only six studies met the inclusion criteria, which evaluated five provocative tests. In general, Spurling's test demonstrated low to moderate sensitivity and high specificity, as did traction/neck distraction, and Valsalva's maneuver. The upper limb tension test (ULTT) demonstrated high sensitivity and low specificity, while the shoulder abduction test demonstrated low to moderate sensitivity and moderate to high specificity. Common methodological flaws included lack of an optimal reference standard, disease progression bias, spectrum bias, and review bias. Limitations include few primary studies, substantial heterogeneity, and numerous methodological flaws among the studies; therefore, a meta-analysis was not conducted. This review suggests that, when consistent with the history and other physical findings, a positive Spurling's, traction/neck distraction, and Valsalva's might be indicative of a cervical radiculopathy, while a negative ULTT might be used to rule it out. However, the lack of evidence precludes any firm conclusions regarding their diagnostic value, especially when used in primary care. More high quality studies are necessary in order to resolve this issue.

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Do Patients Undergoing Physical Testing Report Pain Intensity Reliably?

White

McNair

Laslett

et al. 2015

Arthritis Care & Research

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Objective. To determine the reliability of patient reports of pain intensity during the application of physical tests. Methods. A single examiner required participants to use the numeric pain rating scale (NPRS) to report the intensity of pain provoked during physical testing of the hip. Standardized versions of 14 physical tests were used on 18 people with hip pain. Tests were repeated at 1 hour and 2-7 days later. Within-and between-session reliability of reports of pain intensity was calculated using intraclass correlation coefficients (ICCs) and Lin's concordance correlation coefficients (CCCs). Standard errors of measurement (SEMs) were calculated. The average SEM value of 0.9 points on the NPRS was the same for both within-and between-session testing (range 0.6-1.6). Conclusion. Patient reports of the intensity of pain provoked by physical tests are sufficiently reliable to be clinically useful. However, the SEM of 0.9 points should be considered when precise calculations of changes in pain intensity are important.

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Reliability and Diagnostic Accuracy of the Clinical Examination and Patient Self-Report Measures for Cervical Radiculopathy

Cited by 485 publications

References 45 publications

Interactive cervical motion kinematics: Sensitivity, specificity and clinically significant values for identifying kinematic impairments in patients with chronic neck pain

Interactive cervical motion kinematics: Sensitivity, specificity and clinically significant values for identifying kinematic impairments in patients with chronic neck pain

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

Do Patients Undergoing Physical Testing Report Pain Intensity Reliably?

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