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Diagnostic accuracy of clusters of pain provocation tests for detecting sacroiliac joint pain: systematic review with meta-analysis

Saueressig T, Owen PJ, Diemer F, Zebisch J, Belavy DL

The Journal of Orthopaedic and Sports Physical Therapy 2021 Sep;51(9):422-431

systematic review

OBJECTIVE: To assess the diagnostic test accuracy of pain provocation tests for the sacroiliac joint. DESIGN: Systematic review of diagnostic test accuracy. LITERATURE SEARCH: Eight electronic databases and reference lists of included studies and previous reviews. STUDY SELECTION CRITERIA: Studies investigating the diagnostic accuracy of clusters of clinical tests for sacroiliac joint pain. DATA SYNTHESIS: Bivariate random effects meta-analysis was employed. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool and the GRADE tool to judge credibility of evidence. RESULTS: From 2,195 records identified in the search, five studies were included that assessed clusters of pain provocation tests for the sacroiliac joint. The estimated likelihood ratios (LLR) and diagnostic odds ratio (DOR) were positive LLR (2.13, 95% CI 1.2 to 3.9), negative LLR (0.33, 95% CI 0.11 to 0.72) and DOR (9.01, 95% CI 1.72 to 28.4). GRADE ratings for the outcomes were of very low certainty. Assuming a point prevalence of sacroiliac joint pain of 20%, we calculated positive posterior probability of 35% (95% CI 32% to 37%) and negative posterior probability of 8% (95% CI 6% to 10%). CONCLUSIONS: A positive result on a sacroiliac joint pain provocation test cluster gives the clinician 35% certainty of having correctly identified sacroiliac joint pain. Clusters of pain provocation tests for the sacroiliac joint do not provide sufficient diagnostic accuracy for ruling in the sacroiliac joint as the source of pain. Clinicians can rule out the sacroiliac joint as the source of pain with more confidence-the negative post-test probability indicates the clinician can conclude with 92% certainty that a negative test result is correct.

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