Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain
Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain
复制标题
DOI：
10.1007/s005860050228
复制
发表时间：
2000-04-01
影响因子：
2.8
通讯作者：
Westergaard, J
中科院分区：
文献类型：
--
作者：
Albert, H;Godskesen, M;Westergaard, J
骨盆关节和下背部疼痛是孕妇的一个主要问题，事实证明，这种疼痛不愿进行精确的测量和量化。要开发一个分类系统，所使用的临床测试必须能够区分骨盆和下腰痛；它们还必须具有较高的检查者间可靠性、敏感性和特异性，并且最好是易于执行的。这项研究的目的是描述一种标准化的骨盆检查方法，评估检查人员之间的可靠性，并建立15项临床测试的敏感性和特异性。它被设计为一项纵向、前瞻性、流行病学队列研究。首先，由盲检人员对34名孕妇进行检查，以建立检验员间的可靠性。第二，一组2269名连续怀孕的妇女，每个人都回答了一份问卷，并对骨盆关节和周围区域进行了彻底的、高度标准化的体检(15项测试，48项可能的回答)。报告骨盆关节日常疼痛并从关节有客观发现的女性根据症状被分为四个分类组和一个杂项组。研究结果表明，以百分比计算，主考员之间对测试的一致性很高，在88%到100%之间。使用Kappa系数，大多数测试都保持了较高的一致性：六项测试的主考员间一致性在0.81至1.00之间，三项在0.61至0.80之间，两项在0.60至0.41之间。五项测试显示其敏感度更高。除骨盆地形图的特异度为0.79外，其余各项试验的特异度均在0.98至1.00之间。这些结果表明，骨盆关节临床检查的标准化检查和解释是可能的，从而产生高度的敏感性、特异性和检查者间的可靠性。
Pain in the pelvic joints and lower back, a major problem for pregnant women, has proved resistant to precise measurement and quantification. To develop a classification system, the clinical tests used must be able to separate pelvic from low back pain; they must also have a high inter-examiner reliability, sensitivity and specificity, and preferably be easy to perform. The aim of this study was to describe a standardised way of performing tests for examining the pelvis, and to evaluate inter-examiner reliability, and establish the sensitivity and specificity of 15 clinical tests. It was designed as a longitudinal, prospective, epidemiological cohort study. First, 34 pregnant women were examined by blinded examiners to establish inter-examiner reliability. Second, a cohort of 2269 consecutive pregnant women, each responded to a questionnaire and underwent a thorough and highly standardised physical examination (15 tests with 48 possible responses) of the pelvic joints and surrounding areas. The 535 women who reported daily pain from the pelvic joints and had objective findings from the joints were divided, according to symptoms, into four classification groups and one miscellaneous group. The results of the study showed inter-examiner agreement of the tests was high, calculated in percentage terms, at between 88 and 100%. Using the Kappa coefficient, most tests kept the high agreement: six tests had an inter-examiner agreement of between 0.81 and 1.00, three between 0.61 and 0.80, and two between 0.60 and 0.41. Five tests showed superior sensitivity. The specificity of the tests was between 0.98 and 1.00, except the value for pelvic topography, which was 0.79. These results show that it is possible to standardise examination and interpretation of clinical tests of the pelvic joints, resulting in a high degree of sensitivity, specificity and inter-examiner reliability.