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

Show full item record



Permalink

http://hdl.handle.net/10138/330811

Citation

Pesonen , J , Shacklock , M , Rantanen , P , Mäki , J , Karttunen , L , Kankaanpaa , M , Airaksinen , O & Rade , M 2021 , ' Extending the straight leg raise test for improved clinical evaluation of sciatica : reliability of hip internal rotation or ankle dorsiflexion ' , BMC Musculoskeletal Disorders , vol. 22 , no. 1 , 303 . https://doi.org/10.1186/s12891-021-04159-y

Title: Extending the straight leg raise test for improved clinical evaluation of sciatica : reliability of hip internal rotation or ankle dorsiflexion
Author: Pesonen, Janne; Shacklock, Michael; Rantanen, Pekka; Mäki, Jussi; Karttunen, Lauri; Kankaanpaa, Markku; Airaksinen, Olavi; Rade, Marinko
Contributor organization: Clinicum
Helsinki University Hospital Area
Date: 2021-03-24
Language: eng
Number of pages: 8
Belongs to series: BMC Musculoskeletal Disorders
ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-021-04159-y
URI: http://hdl.handle.net/10138/330811
Abstract: Background The 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. Methods Forty 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. Results The 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. Conclusions ESLR 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.
Subject: Straight leg raise
Sciatica
Lumbar intervertebral disc herniation
Interrater reliability
Structural differentiation
3126 Surgery, anesthesiology, intensive care, radiology
3121 General medicine, internal medicine and other clinical medicine
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion


Files in this item

Total number of downloads: Loading...

Files Size Format View
Extending_the_straight_leg_raise_test_f...pdf 4.920Mb PDF View/Open

This item appears in the following Collection(s)

Show full item record