Accuracy of Physical Exam for Chronic Lumbar Radiculopathy
In total, 116 patients with unilateral chronic lumbar radiculopathy were included. Their clinical and demographic characteristics are summarised in Table 1. Mean age was 42.0 (SD 10.3) years, 68 (58.6%) were males, and the mean duration of symptoms on inclusion was 42.0 (SD 99.0) weeks. Figure 1 shows the results of MRI or CT for the included patients. The overall prevalence of disc herniation at any of the studied lumbar levels (L2 to S1) was 77.8%.
Table 2 shows the frequencies of positive index tests, the overall clinical evaluation, and the imaging findings. Table 3 shows the diagnostic accuracies for the different index tests for detection of the level and side of the nerve root impingement. None of the individual tests were highly accurate, as both sensitivities and specificities were low with wide CIs. All positive LRs were ≤4.0, and all negative LRs ≥0.4.
Table 4 shows that the clinicians' overall evaluations using information from all relevant index tests to predict nerve root impingement were slightly more accurate than each of the individual index tests. ROC analysis of the diagnostic properties of the overall clinical evaluations showed AUCs of 0.95 (95% CI 0.90–1.00) for L4, 0.67 (95% CI 0.56–0.77) for L5, and 0.66 (95% CI 0.54–0.77) for S1 nerve root impingement.
Results
In total, 116 patients with unilateral chronic lumbar radiculopathy were included. Their clinical and demographic characteristics are summarised in Table 1. Mean age was 42.0 (SD 10.3) years, 68 (58.6%) were males, and the mean duration of symptoms on inclusion was 42.0 (SD 99.0) weeks. Figure 1 shows the results of MRI or CT for the included patients. The overall prevalence of disc herniation at any of the studied lumbar levels (L2 to S1) was 77.8%.
Table 2 shows the frequencies of positive index tests, the overall clinical evaluation, and the imaging findings. Table 3 shows the diagnostic accuracies for the different index tests for detection of the level and side of the nerve root impingement. None of the individual tests were highly accurate, as both sensitivities and specificities were low with wide CIs. All positive LRs were ≤4.0, and all negative LRs ≥0.4.
Table 4 shows that the clinicians' overall evaluations using information from all relevant index tests to predict nerve root impingement were slightly more accurate than each of the individual index tests. ROC analysis of the diagnostic properties of the overall clinical evaluations showed AUCs of 0.95 (95% CI 0.90–1.00) for L4, 0.67 (95% CI 0.56–0.77) for L5, and 0.66 (95% CI 0.54–0.77) for S1 nerve root impingement.
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