Extending the straight leg raise test for improved clinical evaluation of sciatica: reliability of hip internal rotation or ankle dorsiflexion

BMC Musculoskeletal Disorders

Pekka Rantanen¹  Markku Kankaanpää²  Jussi Mäki³  Olavi Airaksinen⁴  Janne Pesonen⁴  Lauri Karttunen⁴  Marinko Rade⁵  Michael Shacklock⁶ 

[1] Department of Physical and Rehabilitation Medicine, Helsinki University Hospital, Helsinki, Finland;Department of Physical and Rehabilitation Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland;Department of Physical and Rehabilitation Medicine, Tampere University Hospital, Tampere, Finland;Department of Rehabilitation, Kuopio University Hospital, PL100, 70029 KYS, Kuopio, Finland;Department of Rehabilitation, Kuopio University Hospital, PL100, 70029 KYS, Kuopio, Finland;Department of Surgery (incl. Physiatry), University of Eastern Finland, Kuopio, Finland;Department of Rehabilitation, Kuopio University Hospital, PL100, 70029 KYS, Kuopio, Finland;Department of Surgery (incl. Physiatry), University of Eastern Finland, Kuopio, Finland;Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Orthopaedic and Rehabilitation Hospital “Prim. dr. Martin Horvat”, Rovinj, Croatia;Department of Natural and Health Studies, Juraj Dobrila University of Pula, Pula, Croatia;Department of Rehabilitation, Kuopio University Hospital, PL100, 70029 KYS, Kuopio, Finland;Neurodynamic Solutions, Adelaide, Australia;

关键词: Straight leg raise;    Sciatica;    Lumbar intervertebral disc herniation;    Interrater reliability;    Structural differentiation;   

DOI  :  10.1186/s12891-021-04159-y

来源: Springer

【 摘 要 】

BackgroundThe straight leg raise (SLR) is the most commonly applied physical tests on patients with sciatica, but the sensitivity and specificity ratings for disc hernia and neural compression leave areas for improvement. Hip internal rotation tensions the lumbosacral nerve roots and ankle dorsiflexion tensions the sciatic nerve along its course. We added these movements to the SLR (extended SLR = ESLR) as structural differentiators and tested inter-rater reliability in patients with LBP, with and without sciatica.MethodsForty subjects were recruited to the study by the study controller (SC), 20 in the sciatic group and in the control group. Two independent examiners (E1&E2) performed the ESLR and did not communicate to the subjects other than needed to determine the outcome of the ESLR. First, SLR was performed traditionally until first responses were evoked. At this hip flexion angle, a location-specific structural differentiation was performed to confirm whether the emerged responses were of neural origin. Cohen’s Kappa score (CK) for interrater reliability was calculated for ESLR result in detection of sciatic patients. Also, the examiners’ ESLR results were compared to the traditional SLR results.ResultsThe interrater agreement between Examiner 1 and Examiner 2 for the ESLR was 0.85 (p < 0.001, 95%CI: 0.71–0.99) translating to almost perfect agreement as measured by Cohen’s Kappa When the ESLR was compared to the traditional SLR, the overall agreement rate was 75% (30/40). Kappa values between the traditional SLR and the E1’s or E2’s ESLR results were 0.50 (p < 0.0001; 95%CI 0.27–0.73) and 0.54 (p < 0.0001; 95%CI 0.30–0.77), respectively.ConclusionsESLR with the addition of location-specific structural differentiation is a reliable and repeatable tool in discerning neural symptoms from musculoskeletal in patients with radiating low back pain. We recommend adding these movements to the standard SLR with aim of improving diagnostic ability.

【 授权许可】

CC BY