Conclusions For most clinical tests in LBP there is not consistent evidence for an association with outcome .
Central ization and non-organic signs are exceptions from that .
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 systematic ally 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 .
Predictive tests for non-return to work in patients with chronic low back pain
Abstract . Return to work ( RTW ) is the primary goal in the rehabilitation of patients with chronic low back pain . In spite of expensive rehabilitative efforts , many patients do not RTW . To increase cost effectiveness , predictive tests for non-RTW are needed to select patients for rehabilitation . The reliability of these tests must be high , to prevent exclusion of patients who might improve . This study evaluates the reliability and predictive validity of four tests and the following psychosocial factors for non-RTW : nationality , off-work duration , unemployment and work load . It was design ed as a prospect i ve cohort study of 99 patients with chronic low back pain . Upon entry , physical work load , time off work , unemployment and nationality were recorded . The study investigated four tests with an anticipated prognostic value for non-RTW : the  Numeric Pain Rating Scale ( NRS , 9–10 of a maximum of 10 ) , the  Step Test and Pseudo Strength Test ( precipitous cessation ) and  Behavioural Signs .  After 12 months , the RTW rate was obtained from the physicians responsible for sick-listing by postal survey . The response rate regarding RTW was 91 % at 1 year . The RTW rate at 1 year was 20 % . All investigated tests significantly correlated with non-RTW . Regression analysis showed that the best prediction of non-RTW was obtained when at least two out of the four tests were positive ( positive predictive value 0.97 , sensitivity 0.45 ) . Unemployment , time off work , nationality and physical work load were less predictive . The results show that the combination of the four prognostic tests allows a very reliable prognosis of non-RTW . The cost effectiveness of rehabilitation aim ing at RTW will , therefore , be increased by excluding patients with two or more positive tests
Conclusions For most clinical tests in LBP there is not consistent evidence for an association with outcome .
Central ization and non-organic signs are exceptions from that .
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 systematic ally 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 .