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Table 5 Grade quality assessment for patient history, clinical examination and screening tool data

From: Diagnostic utility of patient history, clinical examination and screening tool data to identify neuropathic pain in low back related leg pain: a systematic review and narrative synthesis

   GRADE Quality assessment
Index test/clinical indicators Sample size Studies per index test/clinical indicator Phenomena of interest Study design RoB Indirectness Inconsistency Imprecision Publication bias Quality
Verwoerd et al’s, (2014) [13] 20 subjective clinical indicators (see Table 4) 395 1 Lumbosacral nerve root compression Cross sectional observational – no limitations in study design Serious RoB (see Table 3 and Fig. 2) Serious indirectness No serious inconsistency No serious imprecision Undetected
LOW a,b
Cluster of two symptoms and one sign: “pain referred in a dermatomal cutaneous distribution”, “History of nerve injury, pathology or mechanical compromise” and “Pain/symptom provocation with mechanical/movement test” 464 1 Peripheral NP in patients with or without leg pain Cross sectional observational – no limitations in study design Serious RoB (see Table 3 and Fig. 2) Serious indirectness No serious inconsistency No serious imprecision Undetected
LOW a,c
Model including: two patient characteristics (age and duration of disease), four symptoms from the history (paroxysmal pain, pain worse in leg than back, typical dermatomal distribution, worse on coughing/sneezing/straining) and two signs from the physical examination (finger to floor distance and Paresis). 274 1 Lumbosacral nerve root compression Cross sectional observational – no limitations in study design No serious RoB (see Table 3 and Fig. 2) Serious indirectness No serious inconsistency No serious imprecision Undetected
MODERATE
3
SLR 2352 1 Sciatica Cross sectional observational – no limitations in study design Serious RoB (see Table 3 and Fig. 2) Serious indirectness No serious inconsistency No serious imprecision Undetected
LOW a,c
SQST 60 1 Lumbar lateral stenosis involving L5 nerve root Cross sectional observational – no limitations in study design Serious RoB (see Table 3 and Fig. 2) Serious indirectness No serious inconsistency No serious imprecision Undetected
LOW a,c,d
Bell’s test, HE test, Lasegue signs, Crossed Lasegue signs 78 1 CLBP with or without leg pain Cross sectional observational – no limitations in study design Serious RoB (see Table 3 and Fig. 2) Serious indirectness No serious inconsistency No serious imprecision Undetected
LOW a,c,e
Slump knee bend 16 1 Upper/mid lumbar nerve root compression Cross sectional observational design – pilot study Serious RoB (see Table 3 and Fig. 2) Serious indirectness No serious inconsistency Serious imprecision Undetected
VERY LOW
1,3,6,7,8
Slump test 21 1 NP in Lower Limb Cross sectional observational – no limitations in study design Serious RoB (see Table 3 and Fig. 2) Serious indirectness No serious inconsistency No serious imprecision Undetected
VERY LOW
1,3,7
Nerve palpation: 2 or more of sciatic, tibial, common peroneal 45 1 LBLP Cross sectional observational – no limitations in study design Serious RoB (see Table 3 and Fig. 2) Serious indirectness No serious inconsistency No serious imprecision Undetected
LOW a,i
S-DN4, ID pain, PDQ, S-LANNS 215 1 CLBP with or without leg pain Cross sectional observational – no limitations in study design Serious RoB (see Table 3 and Fig. 2) Serious indirectness No serious inconsistency No serious imprecision Undetected
LOW a,j
StEP tool 138 1 NP in LBP (radicular) Cross sectional observational – no limitations in study design No serious RoB (see Table 3 and Fig. 2) Serious indirectness No serious inconsistency No serious imprecision Undetected
MODERATE
1,3,11
  1. aDowngraded due to being at “high risk” of bias
  2. b Downgraded due to indirectness observed in study due to highly selective population
  3. c Downgraded due to indirectness observed in study as imaging/examination/opinion were used as reference standards all of which are not validated to identify NP in LBLP
  4. d Downgraded due to indirectness observed in study as population comprised of exclusively surgical patients and thus not representative of those managed conservatively
  5. e Downgraded due to indirectness observed in study as reference standards were poorly specified. The use of MRI, CT and saccoradiculography are described without any description of how each will be assessed
  6. f Downgraded to low quality due to study design. This study was a pilot study
  7. g Downgraded due to indirectness observed in study as small population size was not representative of target population
  8. h Downgraded due to imprecision observed in study as wide confidence intervals noted for all measures of diagnostic accuracy. In particular positive predictive value (22–96%)
  9. i Downgraded due to indirectness observed in study as SLR and Slump test were used as a reference standard which are not validated tests to identify NP in LBLP
  10. j Downgraded due to indirectness observed in study as population included those with LBP with or without leg pain which is not consistent with the target population for this review. Also, the questionnaires used in this study were translated into Hindi and yet to be validated. Furthermore, the description of reference standard, physician opinion, was inadequately described and thus indirect
  11. k Downgraded due to indirectness observed in study as equipment needed for the StEP tool are not readily available in clinical practise