Diagnostic utility of clinical tests for spinal dysfunction

The purpose of this study was to outline the clinical tests that exhibit the highest diagnostic utility for the spine. Using a sensitive search strategy but highly restrictive inclusion criteria based on assessment of quality and reduction of bias, we identified 16 well constructed diagnostic accuracy studies of the spine. Within the 16 studies, 14 clinical tests were identified, and of the 14, four cervical tests and two lumbar tests were considered good screening tools whereas one cervical test and five lumbar tests were considered good tools for confirmatory diagnosis. A significant number of clinical tests were not included in our final tally secondary to poor study designs and the risks associated with inflated findings and bias. High quality diagnostic accuracy studies for the spine are necessary to improve clinicians' abilities to rule out sinister disorders. (C) 2010 Elsevier Ltd. All rights reserved.