Abstract
To investigate agreement and reliability among clinicians when diagnosing low back-related leg pain (LBLP) in primary care consulters. Thirty-six patients were assessed by one of six physiotherapists and diagnosed as having either leg pain due to nerve root involvement (sciatica) or referred leg pain. Assessments were video recorded. In part one, the physiotherapists each viewed videos of six patients they had not assessed. In part two, videos were viewed by another six health professionals. All clinicians made an independent differential diagnosis and rated their confidence with diagnosis (range 50-100%). In part one agreement was 72% with fair inter-rater reliability (K=0.35, 95% CI 0.07, 0.63). Results for part two were almost identical (K=0.34, 95% CI 0.02, 0.69). Agreement and reliability indices improved as diagnostic confidence increased. Reliability was fair among clinicians from different backgrounds when diagnosing LBLP but improved substantially with high confidence in clinical diagnosis.
Highlights
Reliability was fair among clinicians from different backgrounds when diagnosing low back-related leg pain (LBLP) but improved substantially with high confidence in clinical diagnosis
Low back-related leg pain (LBLP) can be classified as either radicular pain due to nerve root involvement (NRI) or referred pain due to back pain spreading down the leg
We have shown that the reliability of diagnosing nerve root involvement in LBLP patients with symptoms of any duration and severity is fair among experienced clinicians
Summary
Low back-related leg pain (LBLP) can be classified as either radicular pain due to nerve root involvement (NRI) or referred (non-specific) pain due to back pain spreading down the leg (from structures such as ligament, joint or disc but not involving a spinal nerve root). The clinical task of differentiating NRI from referred leg pain in LBLP patients is recognized as important in lines with clinical guidelines [1], but can be difficult in clinical practice [2,3,4]. The diagnosis of NRI is predominantly clinical, there is no accepted diagnostic ‘‘gold standard’’. Items from history [5] and physical examination [6] in patients with nerve root symptoms due to disc herniation have mostly shown poor individual diagnostic performance. Literature suggests that in the absence of a well-accepted reference standard, expert clinical opinion may be considered an appropriate alternative for diagnosis, providing that it is reasonably reliable [10]
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