Understanding the Importance of Accurate Diagnosis in Lower Back Pain

Oct 13, 2025 by wbrum.org 94 views

Understanding the Importance of Accurate Diagnosis in Lower Back Pain

Lower back pain is a common musculoskeletal complaint in clinical practice, affecting millions of people worldwide. The high incidence and prevalence of lower back pain, especially lumbosacral radiculopathy, have a significant impact on society, leading to disability and a low quality of life. Therefore, it is essential to have accurate screening and confirmation tests to diagnose lumbosacral radiculopathy. This research focuses on the position of the jackknife, one of the main maneuvers to increase pressure on intervertebral discs.

The Need for Effective Screening Tests

Accurate diagnosis is crucial in managing patients with lower back pain. The Straight Leg Raising Test (SLR), Modified Bragard Test, and Modified Sicard Test are three common lumbosacral provocation tests used to detect lumbosacral radiculopathy. However, the effectiveness of these tests in early screening and initial diagnosis is still unclear. This study aims to compare the three tests and determine the most effective one for early screening and help establish a better initial diagnosis.

Methodology

This study was conducted at the Adam Malik Hajj General Hospital in Medan, Indonesia. Primary data were obtained from patients with lower back pain treated in neurological polyclinics. Twenty-one patients with lower back pain were evaluated using the three provocation tests, and then confirmed through the electrodiagnostic test. The results were analyzed using the 2x2 table and the ROC curve (Receiver Operating Characteristic) to calculate the sensitivity, specificity, and AUC value (under the curve) of each test.

Results

The results of the study showed that the SLR had a sensitivity of 64.7% and specificity of 50.0%, with an AUC value of 0.574 (95%CI 0.251-0.896). The Modified Bragard Test had a sensitivity of 82.4% and specificity of 75.0%, with an AUC value of 0.787 (95%CI 0.514-1,000). Meanwhile, the Modified Sicard Test had a sensitivity of 76.5% and specificity of 50.0%, with an AUC value of 0.632 (95%CI 0.308-0.956).

Comparison of the Tests

Based on the results of the study, the Modified Bragard Test had the highest sensitivity compared to the two other tests. This indicates that the Modified Bragard Test is more effective in detecting lumbosacral radiculopathy. However, it is essential to note that this research has limitations, such as a small sample size.

Conclusion

This study provides important information about the effectiveness of three provocation tests in diagnosing lumbosacral radiculopathy. The finding can help clinicians in choosing the most appropriate test to diagnose early and manage patients with lower back pain. Further research with a larger sample size and stronger design is needed to validate the results of this study.

Implications for Clinical Practice

The results of this study have significant implications for clinical practice. Clinicians can use the Modified Bragard Test as a more effective screening tool for lumbosacral radiculopathy. However, it is essential to consider the limitations of this study and the need for further research to validate the results.

Future Research Directions

Further research is needed to validate the results of this study and to explore the effectiveness of other provocation tests in diagnosing lumbosacral radiculopathy. A larger sample size and stronger design are necessary to increase the validity and reliability of the results. Additionally, research on the cost-effectiveness and feasibility of the Modified Bragard Test in clinical practice is also essential.

Limitations of the Study

This study has several limitations, including a small sample size and a limited number of participants. Additionally, the study was conducted in a single hospital, which may limit the generalizability of the results. Further research is needed to address these limitations and to increase the validity and reliability of the results.

Conclusion

Q: What is the purpose of the study?

A: The purpose of the study is to compare the effectiveness of three provocation tests, namely Straight Leg Raising Test (SLR), Modified Bragard Test, and Modified Sicard Test, in detecting lumbosacral radiculopathy.

Q: What is lumbosacral radiculopathy?

A: Lumbosacral radiculopathy is a condition where there is compression or irritation of the nerve roots in the lower back, leading to pain, numbness, and weakness in the legs.

Q: What are the three provocation tests compared in the study?

A: The three provocation tests compared in the study are:

Straight Leg Raising Test (SLR)
Modified Bragard Test
Modified Sicard Test

Q: What is the Straight Leg Raising Test (SLR)?

A: The Straight Leg Raising Test (SLR) is a test where the patient lies on their back and the examiner lifts one leg, keeping it straight, to assess for pain or numbness in the leg.

Q: What is the Modified Bragard Test?

A: The Modified Bragard Test is a test where the patient lies on their back and the examiner applies pressure to the patient's lower back, while the patient's leg is lifted, to assess for pain or numbness in the leg.

Q: What is the Modified Sicard Test?

A: The Modified Sicard Test is a test where the patient lies on their back and the examiner applies pressure to the patient's lower back, while the patient's leg is lifted, to assess for pain or numbness in the leg.

Q: What were the results of the study?

A: The results of the study showed that the Modified Bragard Test had the highest sensitivity (82.4%) compared to the two other tests, indicating that it is more effective in detecting lumbosacral radiculopathy.

Q: What are the implications of the study for clinical practice?

A: The study's findings suggest that the Modified Bragard Test can be used as a more effective screening tool for lumbosacral radiculopathy. However, further research is needed to validate the results and to explore the effectiveness of other provocation tests in clinical practice.

Q: What are the limitations of the study?

A: The study has several limitations, including a small sample size and a limited number of participants. Additionally, the study was conducted in a single hospital, which may limit the generalizability of the results.

Q: What are the future research directions?

A: Further research is needed to validate the results of the study and to explore the effectiveness of other provocation tests in diagnosing lumbosacral radiculopathy. A larger sample size and stronger design are necessary to increase the validity and reliability of the results.

Q: What is the significance of the study?

A: The study provides important information about the effectiveness of three provocation tests in diagnosing lumbosacral radiculopathy. The findings can help clinicians in choosing the most appropriate test to diagnose early and manage patients with lower back pain.