|dc.identifier.citation||Tawa, N. et al. (2017). Accuracy of clinical neurological examination in diagnosing lumbo-sacral radiculopathy: a systematic literature review. BMC Musculoskeletal Disorders, 18: 93||en_US
|dc.description.abstract||BACKGROUND: Lumbar radiculopathy remains a clinical challenge among primary care clinicians in both assessment
and diagnosis. This often leads to misdiagnosis and inappropriate treatment of patients resulting in poor health
outcomes, exacerbating this already debilitating condition. This review evaluated 12 primary diagnostic accuracy
studies that specifically assessed the performance of various individual and grouped clinical neurological tests in
detecting nerve root impingement, as established in the current literature.
METHODS: Eight electronic data bases were searched for relevant articles from inception until July 2016. All primary
diagnostic studies which investigated the accuracy of clinical neurological test (s) in diagnosing lumbar radiculopathy
among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were
retrieved and independently assessed for methodological quality using the ‘Quality Assessment of Diagnostic tests
Accuracy Studies’ criteria.
RESULTS: A total of 12 studies which investigated standard components of clinical neurological examination of (sensory,
motor, tendon reflex and neuro-dynamics) of the lumbo-sacral spine were included. The mean inter-observer
agreement on quality assessment by two independent reviewers was fair (k = 0.3 – 0.7).
The diagnostic performance of sensory testing using MR imaging as a reference standard demonstrated a sensitivity
(confidence interval 95%) 0.61 (0.47-0.73) and a specificity of 0.63 (0.38-0.84). Motor tests sensitivity was poor to
moderate, ranging from 0.13 (0.04-0.31) to 0.61 (0.36-0.83). Generally, the diagnostic performance of reflex testing was
notably good with specificity ranging from (confidence interval 95%) 0.60 (0.51-0.69) to 0.93 (0.87-0.97) and sensitivity
ranging from 0.14 (0.09-0.21) to 0.67 (0.21-0.94). Femoral nerve stretch test had a high sensitivity of (confidence interval
95%) 1.00 (0.40-1.00) and specificity of 0.83 (0.52-0.98) while SLR test recorded a mean sensitivity of 0.84 (0.72-0.92) and
specificity of 0.78 (0.67-0.87).
CONCLUSION: There is a scarcity of studies on the diagnostic accuracy of clinical neurological examination testing.
Furthermore there seem to be a disconnect among researchers regarding the diagnostic utility of lower limb neurodynamic
tests which include the Straight Leg Raise and Femoral Nerve tests for sciatic and femoral nerve respectively.
Whether these tests are able to detect the presence of disc herniation and subsequent nerve root compression or
hyper-sensitivity of the sacral and femoral plexus due to mechanical irritation still remains debatable.||en_US
|dc.rights||© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.||
|dc.subject||Clinical neurological examination||en_US
|dc.title||Accuracy of clinical neurological examination in diagnosing lumbo-sacral radiculopathy: a systematic literature review||en_US