Are pelvic movement anomalies associated with low back pain of sacroiliac joint origin?

Abstract

Methods: Participants (n= 122) between the ages of 18 to 50 years, suffering from chronic non-specific LBP (≥3 months) volunteered in the study. An experienced musculoskeletal physiotherapist evaluated and classified participants into either a SIJ-positive (n= 45) or a SIJ-negative (n= 77) group, using the reference standard of SIJ pain provocation tests [≥3 positive tests = SIJ-positive], as recommended by current guidelines for pelvic girdle pain. Another musculoskeletal physiotherapist, blinded to the outcome of the reference standard, evaluated participants for reproduction of familiar pain during each increment (10◦, 20◦, 30◦, 40◦, and 50◦) of the HABER test. The association between clinical group and familiar pain reproduction in the HABER test was determined using binary logistic mixed model regression analysis. Sensitivity, specificity, predictive values and likelihood ratios along with their 95% confidence interval were calculated to determine the diagnostic accuracy of HABER test against the reference standard of SIJ pain provocation tests. A receiver operator curve (ROC) analysis was conducted to determine the incremental positions of the HABER test that had the highest sensitivity and specificity for identifying SIJ-positive individuals. Results: Binary logistic regression analysis demonstrated the HABER test significantly reproduced familiar pain in SIJ-positive individuals when compared with SIJ-negative individuals [p< 0.001, R2 = 0.38, Exp(β) = 5.95 to 10.32]. The HABER test overall demonstrated moderate levels of diagnostic accuracy (sensitivity = 67% to 78% and specificity = 71% to 72%), and the incremental test positions of ≥30◦ had the highest sensitivity (83% to 100%) and specificity (52% to 64%) for identifying SIJ-positive LBP individuals. Conclusion(s): The HABER test is capable of reproducing familiar pain in SIJ-positive LBP individuals, and demonstrates acceptable levels of diagnostic accuracy for identifying and discriminating LBP of SIJ origin. Implications: The current study provides a new clinical test for accurate diagnosis of LBP of SIJ origin. We recommend the HABER test be added to the available battery of SIJ clinical tests for improving the sensitivity and specificity of SIJ-positive LBP diagnosis. The high levels of sensitivity of the ≥30◦ HABER’s increment test positions can be used to rule out a SIJ-positive LBP diagnosis. Patients demonstrating familiar pain reproduction at <30◦ of HABER test positions can be considered more likely to have LBP of non-SIJ origin.