Background: There is a strong tradition of performing a clinical examination of low back pain (LBP) patients and
this is generally recommended in guidelines. However, establishing a pathoanatomic diagnosis does not seem
possible in most LBP patients and clinical tests may potentially be more relevant as prognostic factors. The aim of
this review of the literature was to systematically assess the association between low-tech clinical tests commonly
used in adult patients with acute, recurrent or chronic LBP and short- and long-term outcome.
Methods: MEDLINE, Embase, and MANTIS were searched from inception to June 2012. Prospective clinical studies
of adult patients with LBP with or without leg pain and/or signs of nerve root involvement or spinal stenosis,
receiving non-surgical or no treatment, which investigated the association between low-tech clinical tests and
outcome were included. Study selection, data extraction and appraisal of study quality were performed
independently by two reviewers.
Results: A total of 5,332 citations were retrieved and screened for eligibility, 342 articles were assessed as full text
and 49 met the inclusion criteria. Due to clinical and statistical heterogeneity, qualitative synthesis rather than
meta-analysis was performed. Associations between clinical tests and outcomes were often inconsistent between
studies. In more than one third of the tests, there was no evidence of the tests being associated with outcome.
Only two clinical tests demonstrated a consistent association with at least one of the outcomes: centralization and
Conclusions: For most clinical tests in LBP there is not consistent evidence for an association with outcome.
Centralization and non-organic signs are exceptions from that. None of the other clinical tests have been
investigated in confirmatory studies and study quality is generally low. There is a need for hypothesis testing
studies designed specifically to investigate the prognostic value of the clinical tests, and a need for standardization
of the performance and interpretation of tests.
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