Directorate of Physiotherapy, School of Health Sciences, University of Liverpool, Liverpool, UK.
Physiotherapy. 2011 Mar;97(1):59-64. doi: 10.1016/j.physio.2010.05.004. Epub 2010 Aug 1.
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.
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.
Orthopaedic spinal clinic, secondary care.
Sixteen patients with radicular leg pain.
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).
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.
有人提出神经动力学检查有助于鉴别上/中腰椎神经根受压；然而，其中许多检查的诊断准确性尚未得到证实。本初步研究旨在确定 slumped knee bend 神经动力学检查在上/中腰椎神经根受压患者中诊断腰骶神经根痛的诊断准确性。
两位独立的检查者对有神经根性腿痛的患者进行 slumped knee bend 测试。使用 Kappa 系数计算组内一致性。将 slumped knee bend 测试结果与磁共振成像结果进行比较，并计算诊断准确性指标，包括敏感性、特异性、预测值和似然比。
矫形脊柱诊所，二级护理。
16 例有神经根性腿痛的患者。
磁共振成像显示有 4 例中腰椎神经根受压的患者， slumped knee bend 试验均正确识别；然而，在没有这种情况的 2 例患者中，它是假阳性的。 slumped knee bend 测试的组内一致性使用 Kappa 系数为 0.71（95%置信区间 0.33 至 1.0）。 slumped knee bend 测试的诊断有效性计算（95%置信区间）为：敏感性，100%（40 至 100%）；特异性，83%（52 至 98%）；阳性预测值，67%（22 至 96%）；阴性预测值，100%（69 至 100%）；阳性似然比，6.0（1.58 至 19.4）；阴性似然比，0（0 至 0.6）。
结果表明组内一致性良好，并表明 slumped knee bend 测试有可能成为识别中腰椎神经根受压患者的有用临床测试。需要在更多患者中进行进一步研究以确认这些发现。
