The Reliability of Selected Pain Provocation Tests for Sacroiliac Joint Pathology

Laslett, Mark; Williams, Maynard

doi:10.1097/00007632-199405310-00009

Cited by 233 publications

(153 citation statements)

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“…However, we want to stress that none of the six therapists was specially trained in manipulative techniques. This concurs with Laslett and Williams [10], who also demonstrate a high inter-examiner reliability with therapists who have standardised the performance and interpretation of the tests. Herzog et al [6] show that examiners with high levels of clinical experience have a lower intraexaminer reliability than examiners with less experience.…”

Section: Discussionsupporting

confidence: 85%

“…Several investigators argue that pain provoking tests are most efficacious in establishing a diagnosis [10,12,17,22]. However, the Separation and Compression tests were the only such tests used by these investigators [12,17,22].…”

Section: Discussionmentioning

confidence: 99%

“…Pain-provoking tests, the aim of these being to stress the structures, thus attempting to reproduce the patient's symptoms [10] As demonstrated in previous studies [8,17,20,22], assessment of the topographic relations in the pelvis, not to mention movements in the pelvic joints, is difficult to perform in an objective manner and with adequate inter-examiner consistency. The authors of these studies concur, moreover, with Laslett and Williams [10] and Östgaard et al [15], that only pain-provoking tests yield the required objectivity and reproducibility. The difference in results, and often low inter-examiner reliability in different tests is often due to the fact that many tests, even if they are called the same, are performed and evaluated differently.…”

Section: Hanne Albert Mona Godskesen Jes Westergaardmentioning

confidence: 99%

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Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain

Albert

Godskesen

Westergaard

2000

European Spine Journal

171

139

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IntroductionPelvic joint pain and low back pain must be considered a major problem for pregnant women, with reported incidences varying from 4 to 78% [1,7,13,14]. The disparity between these figures suggests the need for consistent classification criteria. It also suggests a certain level of diagnostic confusion, which increases the likelihood of inappropriate treatment.Previous investigations, as well as clinical experience, reveal that symptom complexes in those suffering pain from the pelvic joints differ sharply from symptom complexes related to pain coming from the lower back [5,14,16,19]. The therapy differs too [7,8,19].Abstract Pain in the pelvic joints and lower back, a major problem for pregnant women, has proved resistant to precise measurement and quantification. To develop a classification system, the clinical tests used must be able to separate pelvic from low back pain; they must also have a high inter-examiner reliability, sensitivity and specificity, and preferably be easy to perform. The aim of this study was to describe a standardised way of performing tests for examining the pelvis, and to evaluate interexaminer reliability, and establish the sensitivity and specificity of 15 clinical tests. It was designed as a longitudinal, prospective, epidemiological cohort study. First, 34 pregnant women were examined by blinded examiners to establish inter-examiner reliability. Second, a cohort of 2269 consecutive pregnant women, each responded to a questionnaire and underwent a thorough and highly standardised physical examination (15 tests with 48 possible responses) of the pelvic joints and surrounding areas. The 535 women who reported daily pain from the pelvic joints and had objective findings from the joints were divided, according to symptoms, into four classification groups and one miscellaneous group. The results of the study showed inter-examiner agreement of the tests was high, calculated in percentage terms, at between 88 and 100%. Using the Kappa coefficient, most tests kept the high agreement: six tests had an inter-examiner agreement of between 0.81 and 1.00, three between 0.61 and 0.80, and two between 0.60 and 0.41. Five tests showed superior sensitivity. The specificity of the tests was between 0.98 and 1.00, except the value for pelvic topography, which was 0.79. These results show that it is possible to standardise examination and interpretation of clinical tests of the pelvic joints, resulting in a high degree of sensitivity, specificity and inter-examiner reliability.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Hanne Albert Mona Godskesen Jes Westergaardmentioning

confidence: 99%

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Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain

Albert

Godskesen

Westergaard

2000

European Spine Journal

171

139

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“…The positive results are in some contrast to previous studies of the clinical examination of, e.g. sacroiliac joints, which have come to the conclusion that pain provoking tests are superior to other kinds of examination [13]. Studies of the examination of the lumbar spine have reported varying results [6,21].…”

Section: Discussioncontrasting

confidence: 63%

Intra-observer and inter-observer agreement of the manual examination of the lumbar spine in chronic low-back pain

et al. 2006

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Examination is a cornerstone in the manual procedures leading to mobilisation/manipulation of the low back. The observer variation of the more specific segmental tests remains to be investigated. Two skilled specialists in manual medicine examined the segmental changes in the lumbar spine. The patients were unknown to the examiners and no information of the case history was given. All test results were recorded by an observer present in the room who ensured that no conversation was allowed during the examination. The primary outcome measures were the kappa values for each test. The matching was defined as acceptable (acc) within two neighbouring levels and perfect (per) on the same level. Intra-observer variation (tested in 33 patients and 10 subjects without low-back pain): The agreement between first and second segmental diagnosis examination was 70% (per) and 82% (per + acc).

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“…18 Poor reproducibility may reflect the design of reproducibility studies, rather than the quality of the palpation procedure. 19 In the SI joints, palpation for movement restriction, with or without pain provocation, has been shown to be reliable 20,21 and valid, 22,23 particularly when multiple tests are used. Results from reliability studies of motion palpation procedures are not entirely conclusive, 18 and discounting the use of dynamic palpation as a part of the clinical evaluation would be premature and not clinically reasonable.…”

Section: Interventionmentioning

confidence: 99%

Effect of chiropractic treatment on hip extension ability and running velocity among young male running athletes

Sandell¹,

Palmgren²,

Björndahl³

2008

Journal of Chiropractic Medicine

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Objective: This study investigates the effect of chiropractic treatment on hip joint extension ability and running velocity. Methods: This was a prospective, randomized, controlled experimental pilot study. Seventeen healthy male junior athletes (age, 17-20 years) training in middle distance running were recruited from local Swedish athletic associations. Hip extension ability and running velocity were measured before and after the study period. Chiropractic investigations comprised motion palpation of the sacroiliac and hip joints and modified Thomas test of the ability to extend the leg. In the treatment group, findings of restrictive joint dysfunctions formed the basis for the choice of chiropractic treatment. The interventions were based on a pragmatic approach consisting of high-velocity, low-amplitude manipulations targeted toward, but not exclusively to, the sacroiliac joints. Results: The treatment group showed significantly greater hip extension ability after chiropractic treatment than did controls (P b .05). Participants in the treatment group did not show a significant decrease in time for running 30 m after treatment (average, −0.065 seconds; P = .0572), whereas the difference was even smaller for the control subjects (average, −0.003; P = .7344). Conclusions:The results imply that chiropractic treatment can improve hip extensibility in subjects with restriction as measured by the modified Thomas test. It could be speculated that the running step was amplified by increasing the angle of step through facilitated hip joint extension ability. The possible effect of chiropractic treatment to enhance the running velocity, by increasing the hip joint extension ability and thereby increasing the running step, remains unproven.

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The Reliability of Selected Pain Provocation Tests for Sacroiliac Joint Pathology

Abstract: Five of seven tests employed in this study were reliable, the other two were potentially reliable. These tests may be used to detect a sacroiliac source of low back pain, although sensitivity and specificity studies are needed to determine their diagnostic power.

Cited by 233 publications

References 0 publications

Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain

Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain

Intra-observer and inter-observer agreement of the manual examination of the lumbar spine in chronic low-back pain

Effect of chiropractic treatment on hip extension ability and running velocity among young male running athletes

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