Consistency of history taking and physical examination in patients with suspected lumbar nerve root involvement

Study Design. A cross-sectional study of interobserver variability in prima ry care patients. Objective. To investigate the consistency of signs and symptoms of nerve ro ot compression in primary care patients with pain irradiating pain into the leg (sciatica). Summary of Background Data. The literature does not report on all the clini cal tests for nerve root compression. in previous studies, most patients ha d low back pain with no irradiation. Often, little information on examinati on technique, proportion of positive test results, or clinical patient char acteristics was provided. Methods. A random selection of 91 patients was investigated by a neurologis t-resident couple. Agreement percentages, proportions of positive test resu lts, and kappas were calculated. Results. The kappa of the overall conclusion after the history taking was 0 .40, increasing to 0.66 after physical examination. Kappas were good for de creased muscle strength and sensory loss (0.57-0.82), intermediate for refl ex changes (0.42-0.53), and poor for the examination of the lumbar spine (0 .16-0.33). The straight leg raising, crossed straight leg raising, Bragard' s sign, and Naffziger's sign were the most consistent nerve root tension si gns (> 0.66). Conclusions, Two clinicians disagreed on the presence of nerve root involve ment in one of four patients after history taking, and in one of five patie nts after physical examination. For a more consistent overall diagnosis, th e physician probably should put more emphasis on the history of pain on cou ghing-straining-sneezing, a feeling of coldness in the legs, and urinary in continence. The investigation of paresis, sensory loss, reflex changes, str aight leg raising, and Bragard's sign provide the most consistent results.