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Evidence summaries

Diagnosis of Low Back Pain in General Practice

Patient history and erythrocyte sedimentation rate (ESR) may be of help in the diagnosis of vertebral cancer metastasis, and getting out of bed at night and reduced lateral mobility may increase the likelihood of ankylosing spondylitis. Level of evidence: "C"

A systematic review 1 including 36 observational studies was abstracted in DARE. 4 studies were on history (n=844), 8 on physical examination (n=3 476) and 2 on erythrocyte sedimentation rate (n=1 421). 9 studies were on vertebral cancer metastasis and 8 studies were on ankylosing spondylitis.

For radiculopathy, no single test had a high sensitivity or specificity. History and erythrocyte sedimentation rate had relatively high diagnostic accuracy in vertebral cancer. Getting out of bed at night and reduced lateral mobility seemed to be the only moderately accurate items in ankylosing spondylitis.

    References

    • van den Hoogen HM, Koes BW, van Eijk JT, Bouter LM. On the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain in general practice. A criteria-based review of the literature. Spine 1995 Feb 1;20(3):318-27. [PubMed] [DARE]

Primary/Secondary Keywords