Exploratory study for clinical signs of MODIC changes in patients with low-back pain in the Netherlands armed forces
Abstract Background Magnetic resonance imaging (MRI) is being used extensively in the search for pathoanatomical factors contributing to low back pain (LBP) such as Modic changes (MC). However, it remains unclear whether clinical findings can identify patients with MC. The purpose of this explorativ...
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doaj-8edbf1282cc446a8b947a3d21593c2642020-11-25T03:15:06ZengBMCChiropractic & Manual Therapies2045-709X2019-02-012711810.1186/s12998-018-0229-4Exploratory study for clinical signs of MODIC changes in patients with low-back pain in the Netherlands armed forcesPeter van der Wurff0Tom Vredeveld1Caroline van de Graaf2Rikke K. Jensen3Tue S. Jensen4Research and Development, Military Rehabilitation Centre AardenburgSchool of Physiotherapy, Faculty of Heath, Amsterdam University of Applied SciencesResearch and Development, Military Rehabilitation Centre AardenburgNordic Institute of Chiropractic and Clinical BiomechanicsNordic Institute of Chiropractic and Clinical BiomechanicsAbstract Background Magnetic resonance imaging (MRI) is being used extensively in the search for pathoanatomical factors contributing to low back pain (LBP) such as Modic changes (MC). However, it remains unclear whether clinical findings can identify patients with MC. The purpose of this explorative study was to assess the predictive value of six clinical tests and three questionnaires commonly used with patients with low-back pain (LBP) on the presence of Modic changes (MC). Methods A retrospective cohort study was performed using data from Dutch military personnel in the period between April 2013 and July 2016. Questionnaires included the Roland Morris Disability Questionnaire, Numeric Pain Rating Scale, and Pain Self-Efficacy Questionnaire. The clinical examination included (i) range of motion, (ii) presence of pain during flexion and extension, (iii) Prone Instability Test, and (iv) straight leg raise. Backward stepwise regression was used to estimate predictive value for the presence of MC and the type of MC. The exploration of clinical tests was performed by univariable logistic regression models. Results Two hundred eighty-six patients were allocated for the study, and 112 cases with medical records and MRI scans were available; 60 cases with MC and 52 without MC. Age was significantly higher in the MC group. The univariate regression analysis showed a significantly increased odds ratio for pain during flexion movement (2.57 [95% confidence interval (CI): 1.08–6.08]) in the group with MC. Multivariable logistic regression of all clinical symptoms and signs showed no significant association for any of the variables. The diagnostic value of the clinical tests expressed by sensitivity, specificity, positive predictive, and negative predictive values showed, for all the combinations, a low area under the curve (AUC) score, ranging from 0.41 to 0.53. Single-test sensitivity was the highest for pain in flexion: 60% (95% CI: 48.3–70.4). Conclusion No model to predict the presence of MC, based on clinical tests, could be demonstrated. It is therefore not likely that LBP patients with MC are very different from other LBP patients and that they form a specific subgroup. However, the study only explored a limited number of clinical findings and it is possible that larger samples allowing for more variables would conclude differently.http://link.springer.com/article/10.1186/s12998-018-0229-4Modic changesClinical testsDiagnostic valueMagnetic resonance imagingLow-back pain |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Peter van der Wurff Tom Vredeveld Caroline van de Graaf Rikke K. Jensen Tue S. Jensen |
spellingShingle |
Peter van der Wurff Tom Vredeveld Caroline van de Graaf Rikke K. Jensen Tue S. Jensen Exploratory study for clinical signs of MODIC changes in patients with low-back pain in the Netherlands armed forces Chiropractic & Manual Therapies Modic changes Clinical tests Diagnostic value Magnetic resonance imaging Low-back pain |
author_facet |
Peter van der Wurff Tom Vredeveld Caroline van de Graaf Rikke K. Jensen Tue S. Jensen |
author_sort |
Peter van der Wurff |
title |
Exploratory study for clinical signs of MODIC changes in patients with low-back pain in the Netherlands armed forces |
title_short |
Exploratory study for clinical signs of MODIC changes in patients with low-back pain in the Netherlands armed forces |
title_full |
Exploratory study for clinical signs of MODIC changes in patients with low-back pain in the Netherlands armed forces |
title_fullStr |
Exploratory study for clinical signs of MODIC changes in patients with low-back pain in the Netherlands armed forces |
title_full_unstemmed |
Exploratory study for clinical signs of MODIC changes in patients with low-back pain in the Netherlands armed forces |
title_sort |
exploratory study for clinical signs of modic changes in patients with low-back pain in the netherlands armed forces |
publisher |
BMC |
series |
Chiropractic & Manual Therapies |
issn |
2045-709X |
publishDate |
2019-02-01 |
description |
Abstract Background Magnetic resonance imaging (MRI) is being used extensively in the search for pathoanatomical factors contributing to low back pain (LBP) such as Modic changes (MC). However, it remains unclear whether clinical findings can identify patients with MC. The purpose of this explorative study was to assess the predictive value of six clinical tests and three questionnaires commonly used with patients with low-back pain (LBP) on the presence of Modic changes (MC). Methods A retrospective cohort study was performed using data from Dutch military personnel in the period between April 2013 and July 2016. Questionnaires included the Roland Morris Disability Questionnaire, Numeric Pain Rating Scale, and Pain Self-Efficacy Questionnaire. The clinical examination included (i) range of motion, (ii) presence of pain during flexion and extension, (iii) Prone Instability Test, and (iv) straight leg raise. Backward stepwise regression was used to estimate predictive value for the presence of MC and the type of MC. The exploration of clinical tests was performed by univariable logistic regression models. Results Two hundred eighty-six patients were allocated for the study, and 112 cases with medical records and MRI scans were available; 60 cases with MC and 52 without MC. Age was significantly higher in the MC group. The univariate regression analysis showed a significantly increased odds ratio for pain during flexion movement (2.57 [95% confidence interval (CI): 1.08–6.08]) in the group with MC. Multivariable logistic regression of all clinical symptoms and signs showed no significant association for any of the variables. The diagnostic value of the clinical tests expressed by sensitivity, specificity, positive predictive, and negative predictive values showed, for all the combinations, a low area under the curve (AUC) score, ranging from 0.41 to 0.53. Single-test sensitivity was the highest for pain in flexion: 60% (95% CI: 48.3–70.4). Conclusion No model to predict the presence of MC, based on clinical tests, could be demonstrated. It is therefore not likely that LBP patients with MC are very different from other LBP patients and that they form a specific subgroup. However, the study only explored a limited number of clinical findings and it is possible that larger samples allowing for more variables would conclude differently. |
topic |
Modic changes Clinical tests Diagnostic value Magnetic resonance imaging Low-back pain |
url |
http://link.springer.com/article/10.1186/s12998-018-0229-4 |
work_keys_str_mv |
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