Understanding SI Joint Tests and Clinical Prediction Rules

Joanne LaRowe

To become familiar with the psychometric properties of the SI joint special tests To understand the difference between movement palpation tests and pain provocation tests To understand clinical prediction rules and how to use them to evaluate the SI joint

Reliability: their results Sensitivity: someone with the pathology (SnOut: High sensitivity= Rule Out the Condition) Specificity: someone with the pathology (SpIn: High specificity: Rule In the Condition) Positive Likelihood Ratio (+LR): number, the more convincing that the finding suggests the condition Negative Likelihood Ratio ( number is to 0, the less likely the person has the condition Reliability: extent to which clinicians agree on Sensitivity: probability of a positive test result in Specificity: probability of a negative test result in Positive Likelihood Ratio (+LR): the larger the Negative Likelihood Ratio (- -LR): LR): the closer the Jewell, 2010

Poor diagnostic utility of motion palpation tests Broadhust et al. reported poor inter-test reliability in 11 out of 13 motion palpation tests that were used Less than 4 of rotation and up to 1.6 mm of translation at the pelvis Psychometric properties for motion palpation tests are low because of human s inability to detect this small amount of motion Broadhurst et al, 1998 Laslett, 2008

Distraction (Gapping) Compression Thigh Thrust (Femoral Shear) Gaenslen s Test FABER (Patrick s Test) Sacral Thrust

Reliability: 0.88-0.94 Sensitivity: 0.26-0.60 Specificity: 0.73-0.81 +LR: 3.20 -LR: 0.49 Kokmeyer et al, 2002 Laslett et al, 2005 Van der Wurff et al, 2006

Reliability: 0.79-0.93 Sensitivity: 0.60-0.69 Specificity: 0.69-0.70 +LR: 2.20 -LR: 0.46 Kokmeyer et al, 2002 Laslett et al, 2005 Van der Wurff et al, 2006

Reliability: 0.82-0.94 Sensitivity: 0.52-1.0 Specificity: 0.55-0.80 +LR: 0.72-4.07 -LR: 0.18-1.28 Kokmeyer et al, 2002 Laslett et al, 2005 Szadek et al, 2009

Reliability: 0.61-0.82 Sensitivity: 0.50-0.71 Specificity: 0.26-0.79 +LR: 2.21 -LR: 0.66 Kokmeyer et al, 2002 Laslett et al, 2005 Van der Wurff et al, 2006

Reliability: 0.85-0.96 Sensitivity: 0.63-1.0 Specificity: 0.16-0.77 +LR: 0.7 -LR: NR Kokmeyer et al, 2002 Van der Wurff et al, 2006 Szadek et al, 2009

Reliability: 0.66-0.78 Sensitivity: 0.51-0.63 Specificity: 0.29-0.75 +LR: 2.50 -LR: 0.50 Kokmeyer et al, 2002 Laslett et al, 2005 Szadek et al, 2009

Order of tests: Distraction, thigh thrust, compression, sacral thrust and Gaenslan s Distraction test is the most specific test Thigh thrust test is the most sensitive test Values based on a population of patients whose symptoms did not centralize or peripheralize on a McKenzie assessment Laslett et al, 2003

1 positive test 1 positive test 2 positive tests 2 positive tests 3 positive tests 3 positive tests 4 positive tests 4 positive tests 5 positive tests 5 positive tests Sensitivity 1.00 0.93 0.94 0.60 0.27 Specificity 0.44 0.66 0.78 0.81 0.88 When all of the provocation tests are negative, SIJ can be ruled out When all of the provocation tests are positive, SIJ can be ruled out 3 out of 5 positive tests has the strongest combination of psychometric properties Laslett et al, 2003

Tests: Distraction, thigh thrust, compression, FABER and Gaenslan s 3 out of 5 tests positive Sensitivity: 0.85 Specificity: 0.79 +LR: 4.02 Study used SIJ blocks as their gold standard for diagnosing SIJ dysfunction Van der Wurff et al, 2006

1 positive test 1 positive test 2 positive tests 2 positive tests 3 positive tests 3 positive tests 4 positive tests 4 positive tests 5 positive tests 5 positive tests Sensitivity 1.0 0.93 0.85 0.26 0.00 Specificity 0.42 0.58 0.79 0.82 1.0 +LR 1.74 2.18 4.02 1.43 0.00 Used a receiver operating characteristic (ROC) curve that expresses sensitivity against specificity; 3 positives resulted in the greatest area under the curve If 3 out of 5 tests are positive, the probability is between 65%-93% that the SIJ is the cause of the pain If <3 of 5 are positive, the probability is between 72%-99% that the SIJ is not the cause of the pain Van der Wurff et al, 2006

Movement palpation tests do not have strong diagnostic utility in the clinic because of human s inability to detect small amounts of movement at the pelvis Individual pain provocation tests do not have strong psychometric properties 3 out of 5 positive tests have the strongest diagnostic utility Distraction, thigh thrust, compression, sacral thrust and Gaenslan s (after using a McKenzie assessment to rule out likely disc pathology) Distraction, thigh thrust, compression, FABER and Gaenslan s

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