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Chiropractic Research Review

Clinical Assessment Enhanced by Diagnostic Equipment

Clinical procedures alone may sometimes prove inadequate for evaluating low-back pain, particularly if symptoms have lasted for fewer than seven weeks or if radiculopathic evidence is lacking.

Low-back dysfunction also does not always correlate well with physical examination findings, patient history or symptoms, including reported pain. Eighty-seven subjects (46 healthy subjects and 41 presenting with acute low-back pain) were evaluated by clinicians and by a diagnostic machine designed to analyze lumbar spine function under load. Subjects were placed randomly into an "honest" group which was instructed to report their true condition throughout the study, or a "dishonest" group instructed to simulate or dissimulate a condition.

Results: Clinicians performed significantly better than the machine in terms of the honest group, but much more poorly with respect to the dishonest group. By relying primarily on the subject's self-presentation, a clinician may err in evaluating low-back function, especially if patients do not adequately report the nature of their condition. The additional, functional analysis provided by a diagnostic machine emphasizes the importance of accurate reporting by patients and careful clinical and diagnostic scrutiny by doctors.

Gracovetsky SA, Newman NM. Evaluation of clinician and machine performance in the assessment of low back pain. Spine, March 1998;23(5), pp568-75.

Chiropractic Research Review

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