Agreement of clinical examination for low back pain with facet joint origin.
Mantana Vongsirinavarat, Wahyuddin Wahyuddin, Ratchaneewan Adisaiphaopan
PMID 30930584WHAT IT FOUND
Two physical therapists agreed on facet pain exam items more than 70% of the time, but overall facet diagnosis agreement was fair.
Unilateral pain, muscle spasm, and pain with extension plus same-side bending and rotation were least consistent.
Key findings
01The two examiners agreed on more than 70% of cases for every examination item.
02Agreement on the overall conclusion that low back pain came from a facet joint was fair.
03The least consistent items included unilateral pain and muscle spasm on the same side, while muscle spasm, no nerve root pain, and pain with extension plus same-side bending and rotation had fair agreement levels.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only two examiners were tested, and they had practised the procedure together and came from the same school and clinical setting, so their agreement may not represent how different therapists would agree. History questions and manual techniques were not standardised, which may have made answers and palpation findings harder to compare. The sample was 45 patients with chronic low back pain aged 18 to 60, with pain scores between 21 and 79 on a 100 mm scale, and people with suspected serious pathology or recent pain medication were excluded. Some response categories were skewed, which can lower agreement values and makes the results less stable. The study tested agreement between therapists, not accuracy against diagnostic nerve blocks or injections, so it does not show whether the exam correctly identifies facet joint pain.
Declared interests
The authors reported no conflicts of interest, and no financial or material support was received for the work.
The easy way to misread this
Do not conclude that this examination accurately identifies facet joint pain. It tested whether two therapists agreed, not whether they were correct compared with diagnostic nerve blocks, and overall agreement on facet diagnosis was only fair.