Abstract
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.
Perspective
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.
Key words
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Article info
Publication history
Published online: December 22, 2008
Identification
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© 2009 American Pain Society. Published by Elsevier Inc. All rights reserved.
