van der Wurff Peter, Vredeveld Tom, van de Graaf Caroline, Jensen Rikke K, Jensen Tue S
Research and Development, Military Rehabilitation Centre Aardenburg, Doorn, The Netherlands.
2Institute for Human Movement Sciences, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
Chiropr Man Therap. 2019 Feb 14;27:5. doi: 10.1186/s12998-018-0229-4. eCollection 2019.
Magnetic resonance imaging (MRI) is being used extensively in the search for pathoanatomical factors contributing to low back pain (LBP) such as Modic changes (MC). However, it remains unclear whether clinical findings can identify patients with MC. The purpose of this explorative study was to assess the predictive value of six clinical tests and three questionnaires commonly used with patients with low-back pain (LBP) on the presence of Modic changes (MC).
A retrospective cohort study was performed using data from Dutch military personnel in the period between April 2013 and July 2016. Questionnaires included the Roland Morris Disability Questionnaire, Numeric Pain Rating Scale, and Pain Self-Efficacy Questionnaire. The clinical examination included (i) range of motion, (ii) presence of pain during flexion and extension, (iii) Prone Instability Test, and (iv) straight leg raise. Backward stepwise regression was used to estimate predictive value for the presence of MC and the type of MC. The exploration of clinical tests was performed by univariable logistic regression models.
Two hundred eighty-six patients were allocated for the study, and 112 cases with medical records and MRI scans were available; 60 cases with MC and 52 without MC. Age was significantly higher in the MC group. The univariate regression analysis showed a significantly increased odds ratio for pain during flexion movement (2.57 [95% confidence interval (CI): 1.08-6.08]) in the group with MC. Multivariable logistic regression of all clinical symptoms and signs showed no significant association for any of the variables. The diagnostic value of the clinical tests expressed by sensitivity, specificity, positive predictive, and negative predictive values showed, for all the combinations, a low area under the curve (AUC) score, ranging from 0.41 to 0.53. Single-test sensitivity was the highest for pain in flexion: 60% (95% CI: 48.3-70.4).
No model to predict the presence of MC, based on clinical tests, could be demonstrated. It is therefore not likely that LBP patients with MC are very different from other LBP patients and that they form a specific subgroup. However, the study only explored a limited number of clinical findings and it is possible that larger samples allowing for more variables would conclude differently.
磁共振成像（MRI）正被广泛用于寻找导致腰痛（LBP）的病理解剖因素，如Modic改变（MC）。然而，目前尚不清楚临床检查结果能否识别出患有MC的患者。本探索性研究的目的是评估六项临床检查和三份常用于腰痛（LBP）患者的问卷对Modic改变（MC）存在情况的预测价值。
采用2013年4月至2016年7月期间荷兰军事人员的数据进行回顾性队列研究。问卷包括罗兰·莫里斯残疾问卷、数字疼痛评分量表和疼痛自我效能问卷。临床检查包括：（i）活动范围；（ii）屈伸时是否疼痛；（iii）俯卧位不稳定试验；（iv）直腿抬高试验。采用向后逐步回归来估计MC存在情况及MC类型的预测价值。通过单变量逻辑回归模型对临床检查进行探索。
286例患者被纳入研究，其中112例有病历和MRI扫描资料，60例有MC，52例无MC。MC组患者年龄显著更高。单变量回归分析显示，MC组患者屈伸运动时疼痛的优势比显著增加（2.57 [95%置信区间（CI）：1.08 - 6.08]）。对所有临床症状和体征进行多变量逻辑回归分析，结果显示所有变量均无显著相关性。以敏感性、特异性、阳性预测值和阴性预测值表示的临床检查诊断价值，在所有组合中曲线下面积（AUC）得分均较低，范围为0.41至0.53。屈伸时疼痛的单项检查敏感性最高：60%（95% CI：48.3 - 70.4）。
基于临床检查无法证明存在预测MC的模型。因此，患有MC的LBP患者与其他LBP患者不太可能有很大差异，也不太可能构成一个特定的亚组。然而，本研究仅探索了有限数量的临床检查结果，更大样本且纳入更多变量的研究可能会得出不同结论。
