SPINE Volume 26, Number 10, pp 1167–1171 ©2001, Lippincott Williams & Wilkins, Inc.
Reliability and Validity of the Active Straight Leg Raise Test in Posterior Pelvic Pain Since Pregnancy Jan M. A. Mens, MD,*† Andry Vleeming, PhD,* Chris J. Snijders, PhD,‡ Bart W. Koes, PhD,§ and Henk J. Stam, MD, PhD† Pregnancy is frequently complicated by the occurrence of lumbopelvic pain; the reported cumulative 9-month incidence ranges from 48%-56%.2,4,8,12 Posterior pelvic pain since pregnancy (PPPP) is often described as a distinct category.7,12,13,17 It remains questionable whether PPPP is a speciﬁc syndrome or just nonspeciﬁc lumbopelvic pain with an onset during pregnancy or delivery. Regardless of the answer, detailed study on the characteristics of PPPP could provide better understanding of lumbopelvic pain in general. To discriminate patients with PPPP from healthy subjects, various instruments have been investigated. Mobility of the pelvic joints assessed by the Chamberlain method showed a range of motion between the pubic bones of 5.9 3.3 mm in puerperal women with pelvic pain since pregnancy and 1.9 2.2 mm in a group of puerperal women without pelvic pain.1,3 As far as is known, the speciﬁcity of this method was never studied in PPPP with a disease duration exceeding 6 months. In two studies in pregnant women the posterior pelvic pain provocation test (PPPP test) scored high both on sensitivity (0.69 – 0.81) and speciﬁcity (0.80 – 0.90). 7,13 ‘‘Catching’’ of the leg (the phenomenon whereby a patient feels difﬁculty in moving one or both legs forward when walking) is described as a diagnostic sign in PPPP.17 The speciﬁcity of this sign was similar to that of the PPPP test, but its sensitivity was much lower; the reliability of this sign has, as far as we know, never been investigated. The setting provides the opportunity to examine a large group of patients with PPPP. It was noticed that in most patients active raising of one or both legs in the supine position was weak. Many patients report pain during this action, even though most also describe feeling as though they were paralyzed. As early as 1839, the Swedish gynecologist Cederschjold gave a description of ¨ a condition that he called ‘‘joint loosening’’ in pregnant and puerperal women.5 One of the described characteristics was the ‘‘difﬁculty or almost impossibility of even moving the lower limbs.’’ He assessed ‘‘... an instantaneous relief in the pains and the ability to move the limbs when the hips are pressed hard together with the hands.’’ In a previous study, a signiﬁcant association was found between impaired active straight leg raising (ASLR) and radiographically measured mobility of the pelvic joints.11 The aim of the present study is to investigate the usefulness of this phenomenon as a diagnostic instrument in women with PPPP. More speciﬁcally, the reliability and 1167
Study Design. A cross-sectional analysis was performed in a group of women meeting strict criteria for posterior pelvic pain since pregnancy (PPPP). The scores on the Active Straight Leg Raise Test (ASLR test) were compared with the scores of healthy controls. Objectives. To develop a new diagnostic instrument for use in patients with PPPP. The objectives of the present study were to assess the validity and reliability of the ASLR test. Summary of Background Data. Various diagnostic tools are used to diagnose PPPP, but there is still a need for simple tests with high reliability, sensitivity, and speciﬁcity. Methods. Reliability of the ASLR test was assessed in a group of 50 women with lumbopelvic pain of various etiologies and various degrees of severity. Sensitivity was assessed in 200 patients with PPPP and speciﬁcity in 50 healthy women. Sensitivity and speciﬁcity of the ASLR test were compared with the posterior pelvic pain provocation test (PPPP test). Results. The test–retest reliability measured with Pearson’s correlation coefﬁcient between the two ASLR scores 1 week apart was...
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