■初级保健中可用于识别光盘的诊断测试的准确性,骶髂关节,和小关节作为下腰痛的来源是不确定的。
■初级保健中可用的诊断测试的系统评价。MEDLINE,CINAHL,和EMBASE在2006年3月至2023年1月25日之间进行了搜索。成对的评审员独立筛选了所有研究,提取的数据,并使用QUADAS-2评估偏倚风险。对同质研究进行汇集。正似然比(+LR)≥2和负似然比(-LR)≤0.5被认为是有益的。本评论在PROSPERO(CRD42020169828)注册。
■我们纳入了62项研究:35项研究了光盘,14关节面,11骶髂关节,和2调查了持续性下腰痛患者的所有三个结构。对于偏见的风险,域“参考标准”得分最差,然而,大约一半的研究在其他领域均存在低偏倚风险.对于光盘,合并显示椎间盘退变和环状裂的MRI发现分别产生了信息+LRs:2.53(95%CI:1.57-4.07)和2.88(95%CI:2.02-4.10)和-LRs:0.15(95%CI:0.09-0.24)和0.24(95%CI:0.10-0.55)。MRI上Modic1型、Modic2型和HIZ的汇集结果,集中化现象产生了丰富的+LR:10.00(95%CI:4.20-23.82),8.03(95%CI:3.23-19.97),3.10(95%CI:2.27-4.25),和3.06(95%CI:1.44-6.50),但无信息-LRs:0.84(95%CI:0.74-0.96),0.88(95%CI:0.80-0.96),0.61(95%CI:0.48-0.77),和0.66(95%CI:0.52-0.84)。对于小平面关节,合并显示在SPECT上的小关节摄取导致提供信息的LRs:2.80(95%CI:1.82-4.31)和-LRs:0.44(95%CI:0.25-0.77)。对于骶髂关节,疼痛激发试验和无中线下腰痛的组合结果分别为2.41(95%CI:1.89-3.07)和2.44(95%CI:1.50-3.98)和0.35(95%CI:0.12-1.01)和0.31(95%CI:0.21-0.47).放射性核素成像产生的信息性LR7.33(95%CI:1.42-37.80),但无信息性-LR0.74(95%CI:0.41-1.34)。
■光盘有信息诊断测试,骶髂关节,和关节面(只有一个测试)。证据表明,对于一些患有腰背痛的患者,诊断可能是可能的,潜在的指导目标和具体的治疗方法。
■这项研究没有资金。
UNASSIGNED: The accuracy of diagnostic tests available in primary care to identify the disc, sacroiliac joint, and facet joint as the source of low back pain is uncertain.
UNASSIGNED: Systematic review of diagnostic tests available in primary care. MEDLINE, CINAHL, and EMBASE were searched between March 2006 and 25th January 2023. Pairs of reviewers independently screened all studies, extracted data, and assessed risk of bias using QUADAS-2. Pooling was performed for homogenous studies. Positive likelihood ratios (+LR) ≥2 and negative likelihood ratios (-LR) ≤0.5 were considered informative. This review is registered with PROSPERO (CRD42020169828).
UNASSIGNED: We included 62 studies: 35 investigated the disc, 14 the facet joint, 11 the sacroiliac joint, and 2 investigated all three structures in patients with persistent low back pain. For risk of bias, the domain \'reference standard\' scored worst, however approximately half the studies were of low risk of bias for every other domain. For the disc, pooling demonstrated MRI findings of disc degeneration and annular fissure resulted in informative +LRs: 2.53 (95% CI: 1.57-4.07) and 2.88 (95% CI: 2.02-4.10) and -LRs: 0.15 (95% CI: 0.09-0.24) and 0.24 (95% CI: 0.10-0.55) respectively. Pooled results for Modic type 1, Modic type 2, and HIZ on MRI, and centralisation phenomenon yielded informative +LRs: 10.00 (95% CI: 4.20-23.82), 8.03 (95% CI: 3.23-19.97), 3.10 (95% CI: 2.27-4.25), and 3.06 (95% CI: 1.44-6.50) respectively, but uninformative -LRs: 0.84 (95% CI: 0.74-0.96), 0.88 (95% CI: 0.80-0.96), 0.61 (95% CI: 0.48-0.77), and 0.66 (95% CI: 0.52-0.84) respectively. For the facet joint, pooling demonstrated facet joint uptake on SPECT resulted in informative +LRs: 2.80 (95% CI: 1.82-4.31) and -LRs: 0.44 (95% CI: 0.25-0.77). For the sacroiliac joint, a combination of pain provocation tests and absence of midline low back pain resulted in informative +LRs of 2.41 (95% CI: 1.89-3.07) and 2.44 (95% CI: 1.50-3.98) and -LRs of 0.35 (95% CI: 0.12-1.01) and 0.31 (95% CI: 0.21-0.47) respectively. Radionuclide imaging yielded an informative +LR 7.33 (95% CI: 1.42-37.80) but an uninformative -LR 0.74 (95% CI: 0.41-1.34).
UNASSIGNED: There are informative diagnostic tests for the disc, sacroiliac joint, and facet joint (only one test). The evidence suggests a diagnosis may be possible for some patients with low back pain, potentially guiding targeted and specific treatment approaches.
UNASSIGNED: There was no funding for this study.