title: Systematic review of patient history and physical examination to diagnose chronic low back pain originating from the facet joints.
abstract: Patient history and physical examination are frequently used procedures to diagnose chronic low back pain (CLBP) originating from the facet joints, although the diagnostic accuracy is controversial. The aim of this systematic review is to determine the diagnostic accuracy of patient history and/or physical examination to identify CLBP originating from the facet joints using diagnostic blocks as reference standard. We searched MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Collaboration database from inception until June 2016. Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias. We calculated sensitivity and specificity values, with 95% confidence intervals (95% CI). Twelve studies were included, in which 129 combinations of index tests and reference standards were presented. Most of these index tests have only been evaluated in single studies with a high risk of bias. Four studies evaluated the diagnostic accuracy of the Revel's criteria combination. Because of the clinical heterogeneity, results were not pooled. The published sensitivities ranged from 0.11 (95% CI 0.02-0.29) to 1.00 (95% CI 0.75-1.00), and the specificities ranged from 0.66 (95% CI 0.46-0.82) to 0.91 (95% CI 0.83-0.96). Due to clinical heterogeneity, the evidence for the diagnostic accuracy of patient history and/or physical examination to identify facet joint pain is inconclusive. Patient history and physical examination cannot be used to limit the need of a diagnostic block. The validity of the diagnostic facet joint block should be studied, and high quality studies are required to confirm the results of single studies.
  
  
  
  Patient history and physical examination cannot be used to limit the need of a diagnostic block. The validity of the diagnostic facet joint block should be studied, and high quality studies are required to confirm the results of single studies.
authors.affiliation: Department of Health Sciences and the EMGO+ Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands.
authors.forename: E T
authors.initials: ET
authors.lastname: Maas
authors.affiliation: Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: J N S
authors.initials: JN
authors.lastname: Juch
authors.affiliation: Department of Health Sciences and the EMGO+ Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands.|Department of Epidemiology and Biostatistics, VU University Medical Centre Amsterdam, The Netherlands.
authors.forename: R W J G
authors.initials: RW
authors.lastname: Ostelo
authors.affiliation: Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: J G
authors.initials: JG
authors.lastname: Groeneweg
authors.affiliation: Rijnstate Hospital, Velp, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Kallewaard
authors.affiliation: Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: B W
authors.initials: BW
authors.lastname: Koes
authors.affiliation: Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: A P
authors.initials: AP
authors.lastname: Verhagen
authors.affiliation: Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: F J P M
authors.initials: FJ
authors.lastname: Huygen
authors.affiliation: Department of Health Sciences and the EMGO+ Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: van Tulder
mesh_terms: D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology*; D008487:Medical History Taking / Q000379:methods*; D010808:Physical Examination / Q000379:methods*; D021801:Zygapophyseal Joint