Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint (original) (raw)
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The Validity and Reliability of Provocation Tests in the Diagnosis of Sacroiliac Joint Dysfunction
Pain physician, 2018
Although sacroiliac joint dysfunction (SIJD) is generally regarded as a source of lumbar pain, its anatomical position and the absence of a diagnostic 'gold standard' lead to difficulties at examination and differential diagnosis. However, since sacroiliac (SI) joint blocks only provide information about pathologies of joint origin and since SIJD developing secondary to pathologies in structures around the joint can be missed. Provocation and palpation tests also need to be used in diagnosis. The purpose of this study was to examine the reliability of clinical examination and provocation tests used in the diagnosis of SIJD. Retrospective analysis of prospectively collected data. Outpatient physical medicine and rehabilitation clinic. One hundred and seventeen patients presenting with lumbar and/or leg pain and diagnosed with SIJD through clinical evaluation were included in the study. Range of lumbar joint movement, pain location and specific tests used in the diagnosis of S...
Inter-examiner and intra-examiner reliability of the seated flexion test
2000
Background: Motion palpation is widely used in the field of manual medicine despite a lack of research demonstrating its reliability. The seated flexion test is a motion test that has been advocated for the detection of sacroiliac joint dysfunction and has not been examined for reliability. Objective: The aim of this study was to determine the inter-and intra-examiner reliability of the seated flexion test, and examine the influence of examiner training on reliability. Methods: Ten final year osteopathic students were recruited as examiners. Five of the examiners participated in two training sessions to standardise the testing protocol whilst the remaining five examiners did not participate. The ten examiners performed the test on ten asymptomatic women, three times each. Results: The mean inter-examiner reliability coefficient (k) was 0.105, indicating "slight" agreement, whereas the mean inter-examiner reliability (k) was 0.213, indicating "fair" agreement. Reliability of the trained group was slightly higher for both intra-examiner reliability (k=0.41) and inter-examiner reliability (k=0.14). Conclusion: Examiner training appeared to produce a slight improvement in the inter-examiner and intra-examiner reliability of the seated flexion test. Neither group, however, achieved acceptable reliability for the seated flexion test to be recommended as a useful clinical test.
The reliability of multitest regimens with sacroiliac pain provocation tests
Journal of Manipulative and Physiological Therapeutics, 2002
Background: Studies concerning the reliability of individual sacroiliac tests have inconsistent results. It has been suggested that the use of a test regimen is a more reliable form of diagnosis than individually performed tests. Objective: To assess the interrater reliability of multitest scores by using a regimen of 5 commonly used sacroiliac pain provocation tests. Methods: Two examiners examined 78 subjects. The threshold for a positive selection was set at 3 positive tests out of 5 tests performed. The test order and the order in which the subjects were examined were randomized per patient, and the examiners were blinded from all information regarding the subjects tested. Fifty-nine of the subjects were symptomatic for low back pain, and 19 of the subjects were asymptomatic. Weighted kappa statistic, bias-adjusted kappa, prevalence-adjusted kappa, and 95% CI intervals were used to evaluate the interrater reliability of the test regimen. Results: Weighted kappa was found to be 0.70 (95% CI = 0.45-0.95). Conclusions: A multitest regimen of 5 sacroiliac joint pain provocation tests is a reliable method to evaluate sacroiliac joint dysfunction, although further study is needed to assess the validity of this test method.
https://www.ijhsr.org/IJHSR\_Vol.13\_Issue.7\_July2023/IJHSR-Abstract42.html, 2023
Background: Low back torment (LBP) is normal outer muscle objections in the present social orders. The commonness of low back torment is 70-80% in the western populace. The pervasiveness shows 15-30 % of people with low back pain having inclusion of sacroiliac joint as the origin. Past examinations on the dependability of agony incitement tests have shown uncertain and showing unfortunate unwavering quality when performed with mix of movement palpation tests. The aim of the study is to find the inter-rater reliability of pain incitement tests in low back pain patients to survey sacroiliac joint dysfunctions Indian populace. Materials & Methods: Inter-rater reliability of sacroiliac joint pain provocation tests. Total 30 patients with low back pain were included in the study based on the pain evaluation and inclusion criteria, and patients were assessed by using pain provocation tests. Results & Analysis: The kappa value ranged 0.58-0.60 (p = <0.05) and 0.65-0.66 (p=0.05), 95% CI-0.60-0.78, when compared to the ICC classification of kappa values. Conclusion: The results are showing modest to strong reliability in this study. These tests are reliable and may be used to detect a SIJ source of low back pain.
Diagnosis of Sacroiliac Joint Pain: Validity of individual provocation tests and composites of tests
Manual Therapy, 2005
Previous research indicates that physical examination cannot diagnose sacroiliac joint (SIJ) pathology. Earlier studies have not reported sensitivities and specificities of composites of provocation tests known to have acceptable inter-examiner reliability. This study examined the diagnostic power of pain provocation SIJ tests singly and in various combinations, in relation to an accepted criterion standard. In a blinded criterion-related validity design, 48 patients were examined by physiotherapists using pain provocation SIJ tests and received an injection of local anaesthetic into the SIJ. The tests were evaluated singly and in various combinations (composites) for diagnostic power. All patients with a positive response to diagnostic injection reported pain with at least one SIJ test. Sensitivity and specificity for three or more of six positive SIJ tests were 94% and 78%, respectively. Receiver operator characteristic curves and areas under the curve were constructed for various composites. The greatest area under the curve for any two of the best four tests was 0.842. In conclusion, composites of provocation SIJ tests are of value in clinical diagnosis of symptomatic SIJ. Three or more out of six tests or any two of four selected tests have the best predictive power in relation to results of intra-articular anaesthetic block injections. When all six provocation tests do not provoke familiar pain, the SIJ can be ruled out as a source of current LBP. r
Accuracy of the Diagnostic Tests of Sacroiliac Joint Dysfunction
Journal of Chiropractic Medicine, 2020
Objective: The purpose of this study was to assess the reliability and validity of motion palpation and pain provocation compared with sacroiliac joint (SIJ) block as the gold-standard assessment method of patients with sacroiliac joint dysfunction (SIJD). Methods: A cross-sectional study was conducted in the Department of Sports and Exercise Medicine at Rasool Akram Hospital. Forty-eight patients suspected of having SIJD were selected from a total of 150 patients on the basis of a combination of symptoms, physical tests, and magnetic resonance imaging findings. The patients suspected of having SIJD received the SIJ block, to which the accuracy of all the physical tests was compared. Sensitivity, specificity, and positive and negative predictive values were calculated for each test. The receiver operating characteristic curve and the area under the receiver operating characteristic curve were measured. Results: The Flexion, Abduction and External Rotation (FABER) test had the highest specificity and positive predictive values of the physical tests. Furthermore, the combination of the FABER test and the thigh thrust test improved overall diagnostic ability more so than any of the other test combinations. Conclusion: A combination of the motion and provocation tests increased specificity and positive predictive values, and the FABER test had the highest of these single values. The palpation tests did not change after the SIJ block, suggesting that their accuracy cannot be determined using this method.
Inter-rater reliability of diagnostic criteria for sacroiliac joint-, disc- and facet joint pain
Journal of Back and Musculoskeletal Rehabilitation, 2016
BACKGROUND/OBJECTIVE: Several diagnostic criteria sets are described in the literature to identify low back pain subtypes, but very little is known about the inter-rater reliability of these criteria. We conducted a study to determine the reliability of diagnostic tests that point towards SI joint-, disc-or facet joint pain. METHODS: Inter-rater reliability study alongside three randomized clinical trials. Multidisciplinary pain center of general hospital. Patients aged 18 or more with medical history and physical examination suggestive of sacroiliac joint-, disc-and facet joint pain on lumbar level. Making use of nowadays most common used diagnostic criteria, a physical examination is taken independently by three physicians (two pain physicians and one orthopedic surgeon). Inter-rater reliability (Kappa (κ) measure of agreement) and significance (p) between raters are presented. Strengths of agreement, indicated with κ values above 0,20, are presented in order of agreement. RESULTS: One hundred patients were included. None of the parameters from the physical investigation had κ values of more than 0.21 (fair) in all pairs of raters. Between two raters (C and D), there was an almost perfect agreement on three parameters, more specifically "Abnormal sensory and motor examination, hyperactive or diminished reflexes", "Sitting exam shows no reflex, motor or sensory signs in the legs" and "Straight leg raising (Laségue) negative between 30 and 70 degrees of flexion". The "Drop test positive" parameters had moderate strength of agreement between raters A and D and fair strength between raters A and B. The "Digital interspinous pressure test positive" had moderate strength of agreement between raters C and D and fair strength of agreement between raters A and B as well as raters B and C. Three other parameters had a fair strength of agreement between two raters, all other parameters had a slight or poor strength of agreement. Inter-rater reliability, confidence intervals and significance of pooled items for SI joint-, disc-and facet joint pain are represented; κ values for the pooled parameters of the physical examination suggestive of SI joint pain stayed below 0.20 between all raters. The same applies for the pooled parameters of the physical examination suggestive of facet joint or disc pain. CONCLUSIONS: The poor reliability of the diagnostic parameters seriously limits their predictive validity, and as such their use in patients with low back pain for more than 3 months.
Brazilian Journal of Kinanthropometry and Human Performance, 2019
The postural evaluation software (SAPO) has been used as a valuable tool for the analysis of postural alterations, however, such a tool depends on palpation performed by the evaluator. The aim of the present study was to evaluate the inter-and intra-examiner reliability of experienced and inexperienced examiners in measurements derived from the palpation method, and its possible influence on measurements obtained by SAPO. Nine evaluators participated in the study, which were divided into three groups according to experience with respect to palpation (GI: inexperienced group, GSE: semi-experienced group and GE: experienced group). Each evaluator performed the postural analysis of 10 volunteers, which were photographed in orthostatic position, following the SAPO recommendations. The intra-examiner reliability analysis indicated that all three groups had higher, good and moderate mean correlation values for each examiner than low correlations. In the inter-examiner reliability assessment, GE and GSE groups exhibited higher correlation values. The intra-class correlation coefficient, in the single-measure analysis, presented correlation coefficients <0.70 in 9 of the variables analyzed, indicating non-significant correlation. It was concluded that the measures analyzed by SAPO have high intra-examiner reliability. However, regarding inter-examiner reliability, the group composed of inexperienced evaluators presented lower values, suggesting that the experience time may have influenced the inter-examiner reliability regarding postural evaluation. Resumo-O Software de avaliação postural (SAPO) vem sendo utilizado como uma ferra-menta valiosa para a análise das alterações posturais, porém tal ferramenta depende da palpação realizada pelo examinador. O objetivo do presente estudo foi avaliar a fidedignidade inter e intraexaminadores experientes e inexperientes nas medidas derivadas do método de palpação, e sua possível influência sobre as medidas obtidas pelo SAPO. Participaram do estudo nove avaliadores, divididos em três grupos de acordo com a experiência com relação a palpação (GI: grupo inexperiente, GSE: grupo semi experiente e GE: grupo experiente). Cada avaliador re-alizou a análise postural de 10 voluntários, os quais foram fotografados em posição ortostática, seguindo as recomendações do SAPO. A análise da fidedignidade intraexaminadores indicou que os três grupos apresentaram valores de correlação em média mais altos, bons e moderados, do que correlações baixas. Na avaliação da fidedignidade interexaminadores os grupos GE e GSE exibiram valores de correlação mais altos. O coeficiente de correlação intraclasse, na análise de medida única, apresentou índices de correlação <0,70 em 9 das variáveis analisadas, indicando correlação não considerável. Concluiu-se que as medidas analisadas pelo SAPO possuem uma alta fidedignidade intraexaminadores. No entanto, em relação a fidedignidade interexaminadores o grupo composto por examinadores inexperientes com relação a palpação apresentou valores mais baixos, sugerindo que o tempo de experiência dos examinadores pode ter influenciado na fidedignidade interexaminadores da avaliação postural.
Journal of Medical Technology and Physical Therapy วารสารเทคนิคการแพทย์และกายภาพบำบัด, 2010
The purpose of this study was to investigate intrarater reliability of measurement of leg length distance, static palpation at bony landmarks and performing special tests for sacroiliac joint in normal subjects. Thirty male subjects (mean age 20.4 ± 1.4 yrs) were participated by wearing headdress helmet and uniform for blinding the examiners. The subjects were randomized for assessment by a manager and they were examined each station that consisted of spinomalleolar distance, palpations of anterior superior iliac spine (ASIS), posterior superior iliac spine (PSIS), iliac crest, greater trochanter, ischial tuberosity, and special tests which were Weber-Barstow test, long-sitting test, and hip rotation test. The subjects were examined 3 times in each test where the special tests was examined the last sequence. The Data were analyzed by Intraclass Correlation Coefficient and Kappa Coefficient. The result demonatrated that the intrarater reliability in measuring left and right spinomalleolar distance and the distance from navel to ASIS on left and right side were 0.98, 0.99, 0.98, and 0.98, respectively. In addition, the intrarater reliability of static palpation in ASIS, PSIS, iliac crest, greater trochanter, and ischial tuberosity were 1.00, 0.94, 0.96, 0.98, and 0.90, respectively. Furthermore, intrarater reliability of special tests that in Weber-Barstow test, long-sitting test, and hip rotation test were 0.92, 0.97, and 0.95 respectively. In conclusion, the intrarater reliability of leg length distance, static palpation at bony landmarks, and special tests of sacroiliac joint in male subjects were high in this study.