title: Reliability and diagnostic validity of the slump knee bend neurodynamic test for upper/mid lumbar nerve root compression: a pilot study.
abstract: OBJECTIVE
  It has been proposed that neurodynamic examination can assist differential diagnosis of upper/mid lumbar nerve root compression; however, the diagnostic validity of many of these tests has yet to be established. This pilot study aimed to establish the diagnostic validity of the slump knee bend neurodynamic test for upper/mid lumbar nerve root compression in subjects with suspected lumbosacral radicular pain.
  
  
  METHODS
  Two independent examiners performed the slump knee bend test on subjects with radicular leg pain. Inter-tester reliability was calculated using the kappa coefficient. Slump knee bend test results were compared with magnetic resonance imaging findings, and diagnostic accuracy measures were calculated including sensitivity, specificity, predictive values and likelihood ratios.
  
  
  METHODS
  Orthopaedic spinal clinic, secondary care.
  
  
  METHODS
  Sixteen patients with radicular leg pain.
  
  
  RESULTS
  All four subjects with mid lumbar nerve root compression on magnetic resonance imaging were correctly identified with the slump knee bend test; however, it was falsely positive in two individuals without the condition. Inter-tester reliability for the slump knee bend test using the kappa coefficient was 0.71 (95% confidence interval 0.33 to 1.0). Diagnostic validity calculations for the slump knee bend test (95% confidence intervals) were: sensitivity, 100% (40 to 100%); specificity, 83% (52 to 98%); positive predictive value, 67% (22 to 96%); negative predictive value, 100% (69 to 100%); positive likelihood ratio, 6.0 (1.58 to 19.4); and negative likelihood ratio, 0 (0 to 0.6).
  
  
  CONCLUSIONS
  Results indicate good inter-tester reliability and suggest that the slump knee bend test has potential to be a useful clinical test for identifying patients with mid lumbar nerve root compression. Further investigation is needed on larger numbers of patients to confirm these findings.
authors.affiliation: Directorate of Physiotherapy, School of Health Sciences, University of Liverpool, Liverpool, UK. K.L.Trainor@liverpool.ac.uk
authors.forename: Kate
authors.initials: K
authors.lastname: Trainor
authors.forename: Mark A
authors.initials: MA
authors.lastname: Pinnington
mesh_terms: D000328:Adult; D000818:Animals; D005260:Female; D006801:Humans; D007866:Leg; D008159:Lumbar Vertebrae / Q000294:innervation*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications / Q000175:diagnosis*; D015588:Observer Variation; D010146:Pain / Q000209:etiology / Q000534:rehabilitation*; D010865:Pilot Projects; D013126:Spinal Nerve Roots / Q000293:injuries*