title: Validity of Commonly Used Clinical Tests to Diagnose and Screen for Spinal Pain in Adolescents: A School-Based Cohort Study in 1300 Danes Aged 11-15 Years.
abstract: OBJECTIVE
  The overall aim of this study was to determine the ability of 2 selected clinical tests to detect or predict neck pain, mid back pain, and low back pain in a school-based cohort of Danish 11- to 15-year-olds.
  
  
  METHODS
  A school-based 2-year prospective cohort study was conducted. Data were collected at the age of 11 to 13 (n = 1224) and 2 years later (n = 963). Spinal pain (neck pain, mid back pain, and low back pain) was assessed by an electronic survey completed during school time, and reference standard was defined as both lifetime prevalence and frequent pain as a proxy of severity. The tests included assessments of scoliosis, hypermobility, global mobility, intersegmental mobility, end range pain, and isometric endurance of back extensors. Sensitivity, specificity, negative and positive predictive values, and odds ratios were calculated for each test individually, and area under the receiver operating characteristic curve was calculated for evaluation of all tests combined.
  
  
  RESULTS
  The sensitivity was low, and specificity was high for all tests at both baseline (age, 11-13 years) and follow-up (age, 13-15 years). When all tests were evaluated collectively in 1 model, the area under the receiver operating characteristic curve ranged from 0.60 to 0.65. None of the selected tests could predict incidence cases of neck pain, mid back pain, or low back pain.
  
  
  CONCLUSIONS
  Clinical tests commonly used in spinal screening in adolescents could not detect present spinal pain or predict future spinal pain. However, some statistically significant associations between spinal pain and tests involving a pain response from the participant were found.
authors.affiliation: Research Fellow, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. Electronic address: ellenaartun@hotmail.com.
authors.forename: Ellen
authors.initials: E
authors.lastname: Aartun
authors.affiliation: Professor, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Senior Researcher, Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Hartvigsen
authors.affiliation: Senior Researcher, Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark; Associate Professor, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
authors.forename: Lise
authors.initials: L
authors.lastname: Hestbaek
mesh_terms: D000293:Adolescent; D001416:Back Pain / Q000175:diagnosis*; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D019547:Neck Pain / Q000175:diagnosis*; D010147:Pain Measurement; D010808:Physical Examination / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012600:Scoliosis / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: Adolescent; Back Pain; Diagnosis; Screening