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Active versus passive straight leg raise testing for pain provocation in adults with lumbar neural impingement: a prospective clinical evaluation: Abstracts from Physiotherapy UK Conference 2017, Birmingham, UK, 10-11 November 2017

Research output: Contribution to journalMeeting abstract

M.G. Barcellona, G. Tasker, S. McIlroy

Original languageEnglish
Pages (from-to)e110-e111
JournalPHYSIOTHERAPY
Volume103
Early online date13 Dec 2017
DOIs
Publication statusPublished - Dec 2017

King's Authors

Abstract

Purpose: The straight leg raise (SLR) test is used as a pain provocation manoeuvre to assess for neural mechanosensitivity. Although the SLR was originally described as a passive test, it is often performed actively in the clinical setting. The main purpose of this prospective clinical evaluation was to assess if the active SLR (ASLR) test can be used as a proxy for the passive SLR (PSLR) test for pain provocation in adults with lumbar neural impingement. Level of agreement in terms of ASLR and PSLR test range of motion was also investigated. Methods: A purposive sample of 20 adults with radiographically confirmed lumbar neural impingement (LNI), back and leg pain, attending outpatient clinics at an inner London hospital. SLR range of motion (degrees) was measured to onset of symptoms/discomfort using a digital inclinometer. The SLR test was considered positive if it reproduced the participant's symptoms. ASLR and PSLR was assessed, first on the unaffected and then on the affected side. The order of SLR testing was alternated between participants. Two of each test was performed by one tester, with 60s rests between tests. Level of agreement statistics for pain provocation and range of motion between ASLR and PSLR tests were calculated. ASLR test validity was calculated as sensitivity and specificity of the test compared to PSLR. Results: 11 females and 9 males (age range 23–79 years; 60% disc herniation/protrusion, 40% lumbar stenosis) participated. ASLR and PSLR of the affected side reproduced the participant's symptoms in 55% and 75% of cases, respectively. ASLR and PSLR of the unaffected side reproduced the participant's symptoms in 60% and 40% of cases, respectively. For pain provocation testing there was moderate agreement between ASLR and PSLR on the affected side (κ = 0.58, (95% CI, 0.34–0.79), P < 0.01) and good agreement on the unaffected side (κ = 0.62, (95% CI, 0.43–0.79), P < 0.01). ASLR pain provocation test specificity/sensitivity was 73%/100% and 100%/67% for the affected and unaffected sides, respectively. The 95% level of agreement between PSLR and ASLR range was 55° and 58° for the affected and unaffected sides, respectively. Correlation between PSLR and ASLR was r = 0.80, P < 0.001 and r = 0.83, P < 0.001 for affected and unaffected sides, respectively. Conclusion(s): This is the first study comparing ASLR and PSLR assessment for patients with LNI. There was no statistical difference between PSLR and ASLR as a test for pain provocation with moderate to good levels of agreement between tests. There was large variability between ASLR and PSLR as measures of SLR range of motion. Implications: In adults with LNI there appears to be agreement between ASLR and PSLR testing for pain provocation, suggesting that ASLR can be used as a proxy for PSLR pain provocation testing. Large variability between ASLR and PSLR range of motion measurements means that ASLR should not be used as a proxy for PSLR in terms of assessment of SLR range of motion. Future work is required to corroborate these findings using a larger sample size and with multiple testers. Funding acknowledgements: No funding obtained.

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