Critical Review| Volume 10, ISSUE 4, P354-368, April 2009

Diagnostic Validity of Criteria for Sacroiliac Joint Pain: A Systematic Review

  • Karolina M. Szadek
    Address reprint requests to Dr Karolina M. Szadek, Department of Anesthesiology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
    Department of Anesthesiology, VU University Medical Center, and EMGO Institute for Research in Extramural Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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  • Peter van der Wurff
    Division of Perioperative Medicine and Emergency Care, Department of Anesthesiology and Pain Treatment, University Medical Center, Utrecht, The Netherlands, and Department of Physiotherapy, Military Rehabilitation Centre “Aardenburg,” Doorn, The Netherlands
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  • Maurits W. van Tulder
    Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam and EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
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  • Wouter W. Zuurmond
    Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands
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  • Roberto S.G.M. Perez
    Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands, and EMGO Institute for Research in Extramural Medicine, VU University Medical Center Amsterdam, The Netherlands
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Published:December 22, 2008DOI:


      A systematic literature review was conducted to determine the diagnostic validity of the criteria for sacroiliac (SI) joint pain as proposed by the International Association for the Study of Pain (IASP). Databases were searched up to September 2007. Quality of the studies was assessed using a Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Sensitivity, specificity, and diagnostic odds ratios (DOR) were calculated together with 95% confidence intervals (CI). Statistical pooling was conducted for results of provocative tests. Eighteen studies were included. Five studies examined the pattern of SI joint pain, whereas another 5 examined stressing test specific for SI joint pain. None of the studies evaluated the diagnostic validity of the SI joint infiltration or the diagnostic validity of the IASP criteria set as a whole. In all studies, the SI joint selective infiltration was used as a gold standard; however, the technique, medications, and required pain relief after the infiltration varied considerably between the studies. Taking the double infiltration technique as reference test, the pooled data of the thigh thrust test (DOR, 18.461; CI, 5.82 to 58.53), compression test (DOR, 3.88; CI, 1.7 to 8.9), and 3 or more positive stressing tests (DOR, 17.16; CI, 7.6 to 39) showed discriminative power for diagnosing SI joint pain.


      This review of clinical studies focused on the diagnostic validity of the IASP criteria for diagnosing SI joint pain. A meta-analysis showed that the thigh thrust test, the compression test, and 3 or more positive stressing tests have discriminative power for diagnosing SI joint pain. Because a gold standard for SI joint pain diagnosis is lacking, the diagnostic validity of tests related to the IASP criteria for SI joint pain should be regarded with care.

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