Marije L S Sleijser-Koehorst1, Michel W Coppieters2, Rob Epping3, Servan Rooker4, Arianne P Verhagen5, Gwendolyne G M Scholten-Peeters6. 1. Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands. Electronic address: m.l.s.sleijser-koehorst@vu.nl. 2. Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia. Electronic address: m.coppieters@griffith.edu.au. 3. Paramedisch Centrum Zuid West Nederland, Roosendaal, The Netherlands. Electronic address: epping.rob@gmail.com. 4. Department of Neurosurgery and Orthopaedics, Kliniek ViaSana, Mill, The Netherlands; Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium. Electronic address: s.rooker@viasana.nl. 5. Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia. Electronic address: Arianne.Verhagen@uts.edu.au. 6. Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Department of Neurosurgery and Orthopaedics, Kliniek ViaSana, Mill, The Netherlands. Electronic address: g.g.m.scholten-peeters@vu.nl.
Abstract
OBJECTIVE: To determine the diagnostic accuracy of patient interview items and clinical tests to diagnose cervical radiculopathy. DESIGN: A prospective diagnostic accuracy study. PARTICIPANTS: Consecutive patients (N=134) with a suspicion of cervical radiculopathy were included. A medical specialist made the diagnosis of cervical radiculopathy based on the patient's clinical presentation and corresponding Magnetic Resonance Imaging findings. Participants completed a list of patient interview items and the clinical tests were performed by a physiotherapist. MAIN OUTCOME MEASURES: Diagnostic accuracy was determined in terms of sensitivity, specificity, and positive (+LR) and negative likelihood ratios (-LR). Sensitivity and specificity values ≥0.80 were considered high. We considered +LR≥5 and -LR≤0.20 moderate, and +LR≥10 and -LR≤0.10 high. RESULTS: The history items 'arm pain worse than neck pain', 'provocation of symptoms when ironing', 'reduction of symptoms by walking with your hand in your pocket', the Spurling test and the presence of reduced reflexes showed high specificity and are therefore useful to increase the probability of cervical radiculopathy when positive. The presence of 'paraesthesia' and 'paraesthesia and/or numbness' showed high sensitivity, indicating that the absence of these patient interview items decreases the probability of cervical radiculopathy. Although most of these items had potentially relevant likelihood ratios, none showed moderate or high likelihood ratios. CONCLUSIONS: Several patient interview items, the Spurling test and reduced reflexes are useful to assist in the diagnosis of cervical radiculopathy. Because there is no gold standard for cervical radiculopathy, caution is required to not over-interpret diagnostic accuracy values.
OBJECTIVE: To determine the diagnostic accuracy of patient interview items and clinical tests to diagnose cervical radiculopathy. DESIGN: A prospective diagnostic accuracy study. PARTICIPANTS: Consecutive patients (N=134) with a suspicion of cervical radiculopathy were included. A medical specialist made the diagnosis of cervical radiculopathy based on the patient's clinical presentation and corresponding Magnetic Resonance Imaging findings. Participants completed a list of patient interview items and the clinical tests were performed by a physiotherapist. MAIN OUTCOME MEASURES: Diagnostic accuracy was determined in terms of sensitivity, specificity, and positive (+LR) and negative likelihood ratios (-LR). Sensitivity and specificity values ≥0.80 were considered high. We considered +LR≥5 and -LR≤0.20 moderate, and +LR≥10 and -LR≤0.10 high. RESULTS: The history items 'arm pain worse than neck pain', 'provocation of symptoms when ironing', 'reduction of symptoms by walking with your hand in your pocket', the Spurling test and the presence of reduced reflexes showed high specificity and are therefore useful to increase the probability of cervical radiculopathy when positive. The presence of 'paraesthesia' and 'paraesthesia and/or numbness' showed high sensitivity, indicating that the absence of these patient interview items decreases the probability of cervical radiculopathy. Although most of these items had potentially relevant likelihood ratios, none showed moderate or high likelihood ratios. CONCLUSIONS: Several patient interview items, the Spurling test and reduced reflexes are useful to assist in the diagnosis of cervical radiculopathy. Because there is no gold standard for cervical radiculopathy, caution is required to not over-interpret diagnostic accuracy values.