THE ASSOCIATION BETWEEN CLINICAL FINDINGS ON PHYSICAL-EXAMINATION ANDSELF-REPORTED SEVERITY IN BACK PAIN - RESULTS OF A POPULATION-BASED STUDY

Study design. A cross-sectional population-based study of back pain. O bjective. To evaluate the association between clinical findings on phy sical examination and subjective severity in nonspecific back pain. Su mmary of background data. Assessment of severity of back pain always h as been controversial. Most studies evaluating the role of clinical fi ndings in back pain have been hospital- or clinic-based, often represe nting a highly select population. This selection is avoided in the pop ulation-based approach of the present study. Methods. Approximately 4, 000 German inhabitants of Lubeck, aged 25-74, were selected randomly f rom the local population registry and received a postal questionnaire. Those who reported ''back pain today'' (n = 1200) or ''back pain with in the past 12 months but no back pain before'' (n = 75) were invited to come in for a clinical examination. Thirty-four physical measuremen ts were taken. They were divided into four groups: static measurements , dynamic measurements, neurologic findings, and non-organic physical signs. Self-reported severity of back pain was measured by a pain ques tionnaire and a 12-item activities of daily living list to assess func tional disability. Results. Within each of the four groups of physical measurements, those that corresponded best with the subjective severi ty of back pain could be identified (e.g., rotation, lateral flexion, and fingertip-floor distance; scoliosis, the position of the side plum b line, and pain on percussion of the spine; pseudo-Lasegue and hand m uscle strength). Those that corresponded best could be differentiated statistically from less correlative measurements such as kyphosis and lordosis; flexion of the lumbar, thoracic, or cervical spine; abdomina l muscle strength; and axial loading. The agreement between the classi fication of back pain severity based on clinical findings and the clas sification based on self-reports was moderate (kappa = 0.47). Conclusi ons. Assessment of severity in back pain can only partly be based on t he clinical findings of a physical examination. There is a relatively weak agreement between the results of physical examination and the sub jective reporting of pain and disability.