Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, ST5 5BG, UK.
Eur Spine J. 2012 Nov;21(11):2306-15. doi: 10.1007/s00586-012-2398-5. Epub 2012 Jul 3.
We analysed baseline measures from an RCT involving adults with low back pain (LBP) with or without referred leg pain, to identify self-report items that best identified clinically determined nerve root involvement (sciatica).
Potential indicators of nerve root involvement were gathered using a self-reported questionnaire. Participants underwent a standardised physical examination on the same day as questionnaire completion. Self-reported items were compared to a reference standard (clinical diagnosis) using sensitivity, specificity, predictive values, likelihood ratios (LRs), the area under the receiver operating characteristic curve and logistic regression. Two reference standards are presented: one based on a clinical diagnosis of nerve root problems and excluding possible/inconclusive cases (referred to as a confirmatory reference), and the other being inclusive of possible/inconclusive cases (referred to as an indicative reference).
Pain below knee was the best single item for diagnostic accuracy with an area under curve (AUC) of 0.67-0.68, which however is slightly less than the 'acceptable discrimination'. A cluster of three items, including distribution of pain below the knee, leg pain that is worse than back pain, and feeling of numbness or pins and needles in the leg, did improve discrimination to an 'acceptable' level with an AUC of 0.72-0.74 in relation to confirmatory and indicative references, respectively. However, the likelihood ratios from the models were reflective of a 'small' amount of discrimination.
In this primary care population seeking treatment for LBP with or without leg pain, we found no clear set of self-report items that accurately identified patients with nerve root pain. When accurate case definition is important, clinical assessment should be the method of choice for identifying LBP with possible nerve root involvement.
我们分析了一项涉及伴有或不伴有放射状腿部疼痛的成年人腰痛（LBP）的 RCT 的基线测量值，以确定能最好地识别临床确定的神经根受累（坐骨神经痛）的自我报告项目。
使用自我报告问卷收集神经根受累的潜在指标。参与者在完成问卷的同一天接受了标准化的体格检查。使用敏感性、特异性、预测值、似然比（LR）、受试者工作特征曲线下面积和逻辑回归将自我报告项目与参考标准（临床诊断）进行比较。呈现了两种参考标准：一种基于神经根问题的临床诊断，排除可能/不确定的病例（称为确认性参考），另一种包括可能/不确定的病例（称为指示性参考）。
膝盖以下疼痛是诊断准确性最好的单一项目，曲线下面积（AUC）为 0.67-0.68，但略低于“可接受的区分度”。包括膝盖以下疼痛分布、腿部疼痛比背部疼痛更严重以及腿部麻木或刺痛感在内的三个项目集群，在与确认性和指示性参考相关时，将区分度分别提高到 0.72-0.74，达到“可接受”水平。然而，模型的似然比反映了“小”的区分度。
在这个寻求治疗腰痛伴或不伴腿部疼痛的初级保健人群中，我们没有发现一组能准确识别神经根疼痛患者的明确自我报告项目。当准确的病例定义很重要时，临床评估应该是识别可能存在神经根受累的腰痛的首选方法。
