Evidence and recommendations for the use of segmental motion testing for patients with LBP – A systematic review

Abstract Background Assessment of low back pain (LBP) includes segmental motion tests. Although often used in clinical practice, the validity, inter- and intra-rater reliability of such tests in individuals with LBP are not universally accepted, making it difficult to interpret findings in clinical practice. Objective The purposes of this study were to determine the validity and reliability of segmental motion tests for patients with LBP and to give reasoned recommendations for their use in practice. Design Systematic review. Methods A systematic literature research was conducted of databases PubMed, LIVIVO and Cochrane library. The included studies were appraised for quality by using QUADAS-2 and an adapted version of QAREL tools. Results of studies were appraised to give reasoned recommendations taking quality criteria into account. Results Thirteen studies were included covering passive accessory intervertebral motion testing (PAIVMs), passive physiological intervertebral motion testing (PPIVMs) and the prone instability test (PIT). The risk of bias of studies ranged from high to low. When used in isolation, specificity of PAIVMS and PPIVMs was generally high and sensitivity poor. Reliability was overwhelming poor for both. Reliability of the PIT was inconsistent. None of these assessments can be strongly recommended when used in isolation. Conclusion The evidence regarding validity and reliability of segmental motion testing is poor and clinical use of stand-alone tests cannot be recommended. Superiority of the combination of tests as a test battery or with other clinical information needs further investigation.