BACKGROUND: Low-back pain (LBP) pathophysiological conditions include nociceptive back pain, somatic referred pain, radicular pain (RP), and radiculopathy. Differential diagnosis is challenging; guidance may come from patients' thorough clinical history and physical examination, and particularly, for lumbar RP, from the evaluation of subjective responses of injured lumbar nerves to a strain applied at the buttock (Buttock Applied Strain, BUAS-test). METHODS: In a sample of n=395 consecutive LBP patients, sensitivity, specificity, and prior probability (positive and negative predictive values, PPV and NPV, respectively) of the BUAS-test were evaluated against two Reference tests: the Straight Leg Raising Test (SLRT) and the painDETECT (PD) questionnaire. Multinomial Logistic Regression (MLR) and χ2 analyses were used to evaluate the BUAS-test outcomes dependence upon independent variables (gender, age group, pain localization, SLRT, and PD outcomes). Cohen's Kappa statistic was used to assess inter-rater agreement. RESULTS: Against PD, the BUAS-test showed a sensitivity of 92%, specificity, and PPV of 100%, respectively, and NPV of 82%; against the SLRT, sensitivity and NPV of 82%, respectively, and specificity and PPV of 40%, respectively. Interrater agreement Cohen's Kappa was 0.911. Significant associations were found between BUAS-test outcomes and pain localization, SLRT, and PD outcomes, but not with gender or age group predictors. MLR showed significant congruent relationship between BUAS-test and the PD outcomes. CONCLUSION: Among LBP patients, the BUAS-test showed satisfactory sensitivity, specificity, Prior Probability, and interrater reliability, and thus, it may be considered a useful adjunctive tool to uncover RP in LBP patients. For results generalization, more research, in different clinical settings other than pain clinics, is needed.

Reliability of the Buttock Applied Strain test to uncover radicular pain in Low Back Pain patients

Samolsky Dekel, Boaz Gedaliahu
Writing – Original Draft Preparation
;
Sorella, Maria Cristina
Writing – Review & Editing
;
Vasarri, Alessio
Writing – Review & Editing
;
Melotti, Rita Maria
Writing – Review & Editing
2020

Abstract

BACKGROUND: Low-back pain (LBP) pathophysiological conditions include nociceptive back pain, somatic referred pain, radicular pain (RP), and radiculopathy. Differential diagnosis is challenging; guidance may come from patients' thorough clinical history and physical examination, and particularly, for lumbar RP, from the evaluation of subjective responses of injured lumbar nerves to a strain applied at the buttock (Buttock Applied Strain, BUAS-test). METHODS: In a sample of n=395 consecutive LBP patients, sensitivity, specificity, and prior probability (positive and negative predictive values, PPV and NPV, respectively) of the BUAS-test were evaluated against two Reference tests: the Straight Leg Raising Test (SLRT) and the painDETECT (PD) questionnaire. Multinomial Logistic Regression (MLR) and χ2 analyses were used to evaluate the BUAS-test outcomes dependence upon independent variables (gender, age group, pain localization, SLRT, and PD outcomes). Cohen's Kappa statistic was used to assess inter-rater agreement. RESULTS: Against PD, the BUAS-test showed a sensitivity of 92%, specificity, and PPV of 100%, respectively, and NPV of 82%; against the SLRT, sensitivity and NPV of 82%, respectively, and specificity and PPV of 40%, respectively. Interrater agreement Cohen's Kappa was 0.911. Significant associations were found between BUAS-test outcomes and pain localization, SLRT, and PD outcomes, but not with gender or age group predictors. MLR showed significant congruent relationship between BUAS-test and the PD outcomes. CONCLUSION: Among LBP patients, the BUAS-test showed satisfactory sensitivity, specificity, Prior Probability, and interrater reliability, and thus, it may be considered a useful adjunctive tool to uncover RP in LBP patients. For results generalization, more research, in different clinical settings other than pain clinics, is needed.
Samolsky Dekel, Boaz Gedaliahu; Sorella, Maria Cristina; Vasarri, Alessio; Melotti, Rita Maria
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/754365
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