title: Diagnostic accuracy of self-report and subjective history in the diagnosis of low back pain with non-specific lower extremity symptoms: A systematic review.
abstract: Subjective history questions/self-report items are commonly used to triage the patient with low back pain and related leg symptoms. However the value of the history taking process for decision-making to identify common classifications/diagnosis for patients presenting with low back related leg pain (LBRLP) have not been considered. The purpose of this study was to investigate the diagnostic accuracy of self-report items/history-taking questions used to identify patients with LBRLP. Eligible studies included: 1)subjects with low back pain AND related lower extremity pain, 2)details of subjective examination/self-report items, 3)cohort, prospective/longitudinal studies, and randomized control trials, 4)use of statistical reporting, 5)an acceptable reference standard. Quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2. A synthesis of history items that met the threshold for at least a small shift in the likelihood of the condition with a +LR ≥ 2 or -LR ≤ 0.5 were reported. Conditions commonly reported in the literature: lumbar spinal stenosis, lumbosacral nerve root compression/radiculopathy, disc herniation and neurophysiological low back pain ± leg pain. Eleven studies met the inclusion criteria. This is the first systematic review of diagnostic accuracy studies that examined only the history-taking items for their ability to identify LBRLP conditions. Clustering key items may provide a more precise clinical picture necessary to detect and treat a patient's presentation. History questions formed within the interview and their contributing value for decision-making remain understudied. There is a need for better designs to determine a more accurate diagnostic power to identify conditions with LBRLP.
authors.affiliation: Walsh University, 2020 East Maple Street, North Canton, OH 44720, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Shultz
authors.affiliation: Walsh University, 2020 East Maple Street, North Canton, OH 44720, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Averell
authors.affiliation: Walsh University, 2020 East Maple Street, North Canton, OH 44720, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Eickelman
authors.affiliation: Walsh University, 2020 East Maple Street, North Canton, OH 44720, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Sanker
authors.affiliation: Walsh University, 2020 East Maple Street, North Canton, OH 44720, USA. Electronic address: mismeg77@aol.com.
authors.forename: Megan Burrowbridge
authors.initials: MB
authors.lastname: Donaldson
mesh_terms: D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000503:physiopathology; D035002:Lower Extremity / Q000503:physiopathology; D008487:Medical History Taking; D010147:Pain Measurement; D057566:Self Report
keywords: Diagnostic accuracy; History taking; Low back related leg pain