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

Study Design, A criteria-based review of the literature was conducted regarding ttie accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low buck pain. Objectives. To perform meta-analysis of the literature regarding signs and symptoms fn diagnosing radiculopathy, ankylosing spondylitis, and vertebral cancer Summary of Background Data. Diagnosing low back pain, especiaKy in general practice, depends largely on history taking, physical examination; and the erythrocyte sedimentation rale, No previous review has assessed tho diagnostic accuracy of signs and symptoms in a systematic way, taking into account the methodo/ ogical quaJity of studies, Methods. The literature was reviewed for relevant studies. Retriaved studies were independently rated for rrethOfJdlogical quality by 1wo reviewers. The reported sensitivity and specificity in the rated studies were reviewed. Results. Thiriy-six eligible studies were retrieved. Major methodological shortcomings were absented, and only 19 studios scored s 6 5 points (maximal scare 100). Nat one single test appeared to have high sensitivity and high specificity in radiculopathy. Ttio combined history arid the erythrocyte sedimentation rate had relatively high diagnostic accuracy in vertebral cancer. Getting out of bed at night and reduced lateral mobility teemed to be the only moderately accurate items in ankylosing spondylitis. Cgnclusiorts. Additional studies that take into account tho shortcomings identified would be needed to produce definite contusions. Few of t h e studied signs end symptoms seemed to be valuable diagnostics for radiculopathy, ankylosing spondylitis, and vertebral cancer. Reproducibility of signs and symptoms over time might bs a valuable diagnostic criterion. However, this was neglected In aim-set all studies.