The Reliability of Selected Pain Provocation Tests for Sacroiliac Joint Pathology

Abstract

Objective. To assess the inter-rater reliability of seven pain provocation tests for pain of sacroiliac origin in low back pain patients. Summary of Background Data. Previous studies on the reliability of such tests have produced inconclusive and conflicting results. Methods. Fifty-one patients with low back pain, with or without radiation into the lower limb, were assessed by one examiner and another drawn from a pool of five. Percent agreement and the Kappa statistic were used to evaluate the reliability of the seven tests. Results. Percent agreement and the Kappa statistic ranged in value from 78% and 0.52 (P < 0.001) to 94% and 0.88 (P < 0.001), respectively, when results for all examiner pairs were pooled. However, two tests demonstrated only marginal reliability when performed by one pair of assessors that examined 43% of the patients. Conclusions. Five of seven tests employed in this study were reliable, the other two were potentially reliable. These tests may be used to detect a sacroiliac source of low back pain, although sensitivity and specificity studies are needed to determine their diagnostic power. [Key words: backache, evaluation studies, reproducibility of results, sacroiliac joint] Spine 1994;19: 1243–1249