Scaia Vincent, Baxter David, Cook Chad
Divisionof Physical Therapy,WalshUniversity, 2020 East Maple Street, North Canton, OH 44720, USA.
J Back Musculoskelet Rehabil. 2012;25(4):215-23. doi: 10.3233/BMR-2012-0339.
The purpose of this study was to investigate the diagnostic accuracy of a finding of pain during the straight leg raise test for lumbar disc herniation, lumbar radiculopathy, and/or sciatica.
The systematic review followed the PRISMA guidelines and captured articles that had variable designs, standardized reference standards, described an index test of a pain response, and that reported both sensitivity and specificity for the straight leg raise test. Each article specified that a positive straight leg raise test was one in which the subject felt pain during the administration of the test, and was assessed for quality using the QUADAS tool. Sensitivities and specificities were evaluated along with positive and negative likelihood ratios.
The systematic review and hand search identified 7 articles for inclusion; three of these articles were rated as high quality using QUADAS scores. Sensitivity and specificity varied among the 7 studies with 4 suggesting that a pain response SLR is sensitive whereas 3 suggested it is a specific measure.
Variability in reference standard may partly explain the inconsistencies in the diagnostic accuracy findings. Further, pain that is not specific to lumbar radiculopathy, such as that associated with hamstring tightness, may also lead to false positives for the SLR; and may inflate the sensitivity of the test.
本研究旨在调查直腿抬高试验中出现疼痛这一表现对于腰椎间盘突出症、腰椎神经根病和/或坐骨神经痛的诊断准确性。
本系统评价遵循PRISMA指南，纳入设计多样、参考标准统一、描述了疼痛反应指标试验且报告了直腿抬高试验敏感度和特异度的文章。每篇文章均明确直腿抬高试验阳性是指受试者在试验过程中感到疼痛，并使用QUADAS工具对质量进行评估。同时评估敏感度、特异度以及阳性和阴性似然比。
系统评价和手工检索确定了7篇纳入文章；其中3篇文章根据QUADAS评分被评为高质量。7项研究中敏感度和特异度各不相同，4项研究表明直腿抬高试验出现疼痛反应具有敏感性，而3项研究表明它是一项特异指标。
参考标准的差异可能部分解释了诊断准确性结果的不一致性。此外，并非特定于腰椎神经根病的疼痛，如与腘绳肌紧张相关的疼痛，也可能导致直腿抬高试验出现假阳性；并可能夸大该试验的敏感度。
