Friday, October 3, 2008

Way to go about SI joint testing: The reliability of selected motion- and pain provocation tests for the sacroiliac joint.

Introduction to a debate of specificity & reliability of SI joint tests:
Many authorities on spine and musculoskeletal sciences have surprisingly silent on pain from SI origin while discussing spine but while many other authorities have discussed the context so elaborately that one is flabbergasted about such a gap of opinion. To such a debate, we will start the discussion by introducing the reader to summary of a extensive review by
van der Wurff P et al.
The authors
van der Wurff P et al has reviewed 11 studies which investigated the reliability of different SI tests. The methodological quality of the studies was tested by a list of criteria developed by the authors.
This list consisted of three categories: (1) study population, (2) test procedures and (3) test results. To each criterion a weighting was attached. The methodological score for nine out of the 11 studies was found to be acceptable.
Conclusion from this study:
a. The results of this review, however, could not demonstrate reliable outcomes and therefore no evidence on which to base acceptance of mobility tests of the SIJ into daily clinical practice.
b. There are no indications that 'upgrading' of methodological quality would have improved the final conclusions. With respect to pain provocation tests, the findings did not show the same trend.
c. Two studies demonstrated reliable results using the Gaenslen test and the Thigh thrust test. One study showed acceptable reliability for five other pain provocation tests.
However, since other authors have described contradictory results, there is a necessity for further research in this area with an emphasis on multiple test scores and pain provocation tests of the SIJ.
What many authorities assumed in the past is wrong!!!
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. But as far as current literature concerning the sacroiliac joint (SIJ) goes, there are numerous specific tests used to detect joint mobility or pain provocation.
Where today’s evidence stands: A bird’s eye view
The sacroiliac joint (SIJ) is a potential source of low back and pelvic girdle pain. Diagnosis is made primarily by physical examination using palpation and pain provocation tests.
Robinson HS et al have shown that reliability of the pain provocation tests employed were moderate to good, and for the palpation test, reliability was poor. Previous studies on the reliability of provocation tests have reported inconclusive and conflicting results. Studies concerning the reliability of individual sacroiliac tests have inconsistent results. It has been suggested that the use of a test regimen (cluster of SI joint tests) is a more reliable form of diagnosis than individually performed tests.
1. The need of multitest regimens with sacroiliac pain:
Robinson HS et al have shown that out of one palpation and six pain provocation tests for pain of sacroiliac origin; Clusters out of three and five pain provocation tests were found to be reliable. They further suggested that cluster of tests should be validated for assessment of diagnostic power.
2. The reliability of multitest regimens with sacroiliac pain provocation tests:
Kokmeyer DJ et al tested the reliability of multitest scores by using a regimen of 5 commonly used sacroiliac pain provocation tests. They concluded that; 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.
3. What the prestigious McKenzie Institute clinician’s views are? According to a cluster of 7 SI tests
Laslett M et al of McKenzie Institute International, Wellington, New Zealand found 5 of 7 tests employed in their study were reliable, the other two were potentially reliable. These tests may be used to detect a sacroiliac source of low back pain, although sensitivity and specificity studies are needed to determine their diagnostic power.
4. A valid experimental underpinning of cluster of tests for SI joint dysfunction:
Laslett M et al examined the diagnostic power of pain provocation SIJ tests singly and in various combinations, in relation to an accepted criterion standard.
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.
The conclusion:
Our opinion matches with the conclusion of
Laslett M et al which is as follows- 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. When all six provocation tests do not provoke familiar pain, the SIJ can be ruled out as a source of current LBP.

NB: to know which are the best SI joint cluster of tests write to me or search for more on SI joint tests in this site.

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