Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy.
METHODS
A blinded, prospective diagnostic test study was conducted.


OBJECTIVE
To assess the reliability and accuracy of individual clinical examination items and self-report instruments for the diagnosis of cervical radiculopathy, and to identify and assess the accuracy of an optimum test-item cluster for the diagnosis of cervical radiculopathy.


BACKGROUND
Although cervical radiculopathy remains largely a clinical diagnosis, the reliability and diagnostic accuracy of clinical examination items, individually or in combination, for cervical radiculopathy is largely unknown.


METHODS
Patients with suspected cervical radiculopathy or carpal tunnel syndrome received standardized electrophysiologic examination of the symptomatic upper quarter followed by a standardized clinical examination by physical therapist examiners blinded to diagnosis. Diagnostic properties were assessed using a neural impairment reference criterion standard.


RESULTS
The study involved 82 patients. More than two thirds of 34 clinical examination items had reliability coefficients rated at least fair or better, and 13 items had likelihood ratio point estimates above 2 or below 0.50. A single diagnostic test item cluster of four variables was identified and produced a positive likelihood ratio point estimate of 30.3. The 95% confidence intervals for all likelihood ratio point estimates in this study were wide.


CONCLUSIONS
Many items of the clinical examination were found to be reliable and to have acceptable diagnostic properties, but the test item cluster identified was more useful for indicating cervical radiculopathy than any single test item. Upper limb tension Test A was the most useful test for ruling out cervical radiculopathy. Further investigation is required both to validate the test item cluster and to improve point estimate precision.
Wainner
Robert S
RS
U.S. Army-Baylor Graduate Program in Physical Therapy, Fort Sam, Houston, Texas, USA. robert.wainner@cen.amedd.army.mil
Fritz
Julie M
JM
Irrgang
James J
JJ
Boninger
Michael L
ML
Delitto
Anthony
A
Allison
Stephen
S
D000328:Adult; D003943:Diagnostic Techniques, Neurological / Q000592:standards* / Q000706:statistics & numerical data; D004568:Electrodiagnosis; D004576:Electromyography; D005260:Female; D006304:Health Status; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D009333:Neck; D009460:Neurologic Examination / Q000379:methods / Q000592:standards; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011843:Radiculopathy / Q000145:classification / Q000175:diagnosis*; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D014481:United States