Systematic review of patient history and physical examination to diagnose chronic low back pain originating from the facet joints

E. T. Maas*, J. N.S. Juch, R. W.J.G. Ostelo, J. G. Groeneweg, J. W. Kallewaard, B. W. Koes, A. P. Verhagen, F. J.P.M. Huygen, M. W. van Tulder

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Patient history and physical examination are frequently used procedures to diagnose chronic low back pain (CLBP) originating from the facet joints, although the diagnostic accuracy is controversial. The aim of this systematic review is to determine the diagnostic accuracy of patient history and/or physical examination to identify CLBP originating from the facet joints using diagnostic blocks as reference standard. We searched MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Collaboration database from inception until June 2016. Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias. We calculated sensitivity and specificity values, with 95% confidence intervals (95% CI). Twelve studies were included, in which 129 combinations of index tests and reference standards were presented. Most of these index tests have only been evaluated in single studies with a high risk of bias. Four studies evaluated the diagnostic accuracy of the Revel's criteria combination. Because of the clinical heterogeneity, results were not pooled. The published sensitivities ranged from 0.11 (95% CI 0.02–0.29) to 1.00 (95% CI 0.75–1.00), and the specificities ranged from 0.66 (95% CI 0.46–0.82) to 0.91 (95% CI 0.83–0.96). Due to clinical heterogeneity, the evidence for the diagnostic accuracy of patient history and/or physical examination to identify facet joint pain is inconclusive. Patient history and physical examination cannot be used to limit the need of a diagnostic block. The validity of the diagnostic facet joint block should be studied, and high quality studies are required to confirm the results of single studies. Significance: Patient history and physical examination cannot be used to limit the need of a diagnostic block. The validity of the diagnostic facet joint block should be studied, and high quality studies are required to confirm the results of single studies.

Original languageEnglish
Pages (from-to)403-414
Number of pages12
JournalEuropean Journal of Pain (United Kingdom)
Volume21
Issue number3
DOIs
Publication statusPublished - 1 Mar 2017

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