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Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy.

Wainner, Robert S and Fritz, Julie M and Irrgang, James J and Boninger, Michael L and Delitto, Anthony and Allison, Stephen (2003) Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine (Phila Pa 1976), 28 (1). 52 - 62.

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Abstract

STUDY DESIGN: A blinded, prospective diagnostic test study was conducted. OBJECTIVES: To assess the reliability and accuracy of individual clinical examination items and self-report instruments for the diagnosis of cervical radiculopathy, and to identify and assess the accuracy of an optimum test-item cluster for the diagnosis of cervical radiculopathy. SUMMARY OF BACKGROUND DATA: Although cervical radiculopathy remains largely a clinical diagnosis, the reliability and diagnostic accuracy of clinical examination items, individually or in combination, for cervical radiculopathy is largely unknown. METHODS: Patients with suspected cervical radiculopathy or carpal tunnel syndrome received standardized electrophysiologic examination of the symptomatic upper quarter followed by a standardized clinical examination by physical therapist examiners blinded to diagnosis. Diagnostic properties were assessed using a neural impairment reference criterion standard. RESULTS: The study involved 82 patients. More than two thirds of 34 clinical examination items had reliability coefficients rated at least fair or better, and 13 items had likelihood ratio point estimates above 2 or below 0.50. A single diagnostic test item cluster of four variables was identified and produced a positive likelihood ratio point estimate of 30.3. The 95% confidence intervals for all likelihood ratio point estimates in this study were wide. CONCLUSIONS: Many items of the clinical examination were found to be reliable and to have acceptable diagnostic properties, but the test item cluster identified was more useful for indicating cervical radiculopathy than any single test item. Upper limb tension Test A was the most useful test for ruling out cervical radiculopathy. Further investigation is required both to validate the test item cluster and to improve point estimate precision.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Wainner, Robert S
Fritz, Julie M
Irrgang, James J
Boninger, Michael Lboninger@pitt.eduBONINGER
Delitto, Anthony
Allison, Stephen
Centers: Other Centers, Institutes, or Units > Human Engineering Research Laboratories
Date: 1 January 2003
Date Type: Publication
Journal or Publication Title: Spine (Phila Pa 1976)
Volume: 28
Number: 1
Page Range: 52 - 62
DOI or Unique Handle: 10.1097/01.brs.0000038873.01855.50
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science and Technology
Refereed: Yes
Uncontrolled Keywords: Adult, Diagnostic Techniques, Neurological, Electrodiagnosis, Electromyography, Female, Health Status, Humans, Likelihood Functions, Male, Middle Aged, Neck, Neurologic Examination, Predictive Value of Tests, Prospective Studies, Radiculopathy, Range of Motion, Articular, Reproducibility of Results, Self Efficacy, Surveys and Questionnaires, United States
MeSH Headings: Adult; Diagnostic Techniques, Neurological--standards; Diagnostic Techniques, Neurological--statistics & numerical data; Electrodiagnosis; Electromyography; Female; Health Status; Humans; Likelihood Functions; Male; Middle Aged; Neck; Neurologic Examination--methods; Neurologic Examination--standards; Predictive Value of Tests; Prospective Studies; Questionnaires; Radiculopathy--classification; Radiculopathy--diagnosis; Range of Motion, Articular; Reproducibility of Results; Self Efficacy; United States
PubMed ID: 12544957
Date Deposited: 04 Oct 2012 13:31
Last Modified: 13 Oct 2017 20:57
URI: http://d-scholarship.pitt.edu/id/eprint/14796

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