Total Rehab, Inc, South Ogden, UT.
J Orthop Sports Phys Ther. 2014 Jul;44(7):508-17. doi: 10.2519/jospt.2014.5002. Epub 2014 May 22.
Cross-sectional diagnostic accuracy study.
To investigate the relationship between history and physical examination findings and the outcome of electrodiagnostic testing in patients with sciatica referred to physical therapy.
Electrodiagnostic testing is routinely used to evaluate patients with sciatica. Recent evidence suggests that the presence of radiculopathy identified with electrodiagnostic testing may predict better functional outcomes in these patients. While some patient history and physical examination findings have been shown to predict the presence of disc herniation or neurological insult, little is known about their relationship to the results of electrodiagnostic testing.
Electrodiagnostic testing was performed on 38 patients with sciatica who participated in a randomized trial that compared different physical therapy interventions. The diagnostic gold standard was the presence or absence of radiculopathy, based on the results of the needle electromyographic examination. Diagnostic sensitivity and specificity values were calculated, along with corresponding likelihood ratios, for select patient history and physical examination variables.
No significant relationship was found between select patient history and physical examination findings, analyzed individually or in combination, and the outcome of electrodiagnostic testing. Diagnostic sensitivity values ranged from 0.03 (95% confidence interval [CI]: 0.00, 0.24) to a high of 0.95 (95% CI: 0.72, 0.99), and specificity values ranged from 0.10 (95% CI: 0.02, 0.34) to a high of 0.95 (95% CI: 0.72, 0.99). Positive likelihood ratios ranged from 0.15 (95% CI: 0.01, 2.87) to a high of 2.33 (95% CI: 0.71, 7.70), and negative likelihood ratios ranged from 2.00 (95% CI: 0.35, 11.48) to a low of 0.50 (95% CI: 0.03, 8.10).
In this investigation, the relationship between patient history and physical examination findings and the outcome of electrodiagnostic testing among patients with sciatica was not found to be statistically significant or clinically meaningful. However, given the small sample size and corresponding large CIs, these results should be considered with caution, recognizing that some of the history and physical examination variables may prove useful in future research. These findings suggest that electrodiagnostic testing is essential to identify the subgroup of patients with sciatica who have measurable nerve injury consistent with radiculopathy, which may be an important prognostic factor for recovery. Level of Evidence Diagnosis, level 3b-. J Orthop Sports Phys Ther 2014;44(7):508-517. Epub 22 May 2014. doi:10.2519/jospt.2014.5002.
横断面诊断准确性研究。
调查物理治疗转诊的坐骨神经痛患者的病史和体格检查结果与电诊断测试结果之间的关系。
电诊断测试通常用于评估坐骨神经痛患者。最近的证据表明，电诊断测试中确定的神经根病的存在可能预示着这些患者的功能结果更好。虽然一些患者的病史和体格检查结果已被证明与椎间盘突出或神经损伤的存在有关，但对于它们与电诊断测试结果的关系知之甚少。
对参加比较不同物理治疗干预措施的随机试验的 38 名坐骨神经痛患者进行了电诊断测试。诊断金标准是基于针电极肌电图检查的神经根病的存在或不存在。计算了选择的病史和体格检查变量的诊断灵敏度和特异性值，以及相应的似然比。
未发现选择的病史和体格检查结果之间存在显著关系，无论单独分析还是组合分析，与电诊断测试结果均无显著关系。诊断灵敏度值范围从 0.03（95%置信区间[CI]：0.00，0.24）到 0.95（95%CI：0.72，0.99），特异性值范围从 0.10（95%CI：0.02，0.34）到 0.95（95%CI：0.72，0.99）。阳性似然比范围从 0.15（95%CI：0.01，2.87）到 2.33（95%CI：0.71，7.70），阴性似然比范围从 2.00（95%CI：0.35，11.48）到 0.50（95%CI：0.03，8.10）。
在这项研究中，坐骨神经痛患者的病史和体格检查结果与电诊断测试结果之间的关系没有统计学意义或临床意义。然而，鉴于样本量小且相应的置信区间大，这些结果应谨慎考虑，认识到一些病史和体格检查变量可能在未来的研究中证明有用。这些发现表明，电诊断测试对于识别具有与神经根病一致的可测量神经损伤的坐骨神经痛亚组是必要的，这可能是恢复的一个重要预后因素。证据等级诊断，3b 级。《美国骨科物理治疗杂志》2014 年；44（7）：508-517。2014 年 5 月 22 日电子出版。doi：10.2519/jospt.2014.5002.
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