Stynes, Siobhán Margaret (2017) The diagnosis and classification of low back-related leg pain. Doctoral thesis, Keele University.

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Abstract

Low back-related leg pain (LBLP) is clinically diagnosed as referred leg pain or sciatica. The clinical task of differentiating sciatica from referred leg pain can be challenging but is important for the purpose of treatment choices. There is currently no agreement on which clinical criteria best identify sciatica in clinical or research settings and the spectrum of clinical presentation in patients with LBLP is variable. This thesis aimed to identify diagnostic criteria for sciatica and explore and describe clusters of LBLP patients using cross-sectional data from 609 primary care LBLP consulters.
A systematic literature search of LBLP classification systems showed very few systems specifically addressed LBLP classification. Within the systems, there was wide variation in definitions and clinical features of sciatica, with most systems based on clinical opinion.
Reliability was merely fair (kappa = 0.35) amongst clinicians diagnosing sciatica but at higher levels
of confidence in diagnosis (≥80%), reliability improved (kappa =0.68). Using high confidence clinical diagnosis as a reference standard, with and without confirmatory MRI findings, diagnostic models for sciatica were developed and compared. A simple scoring tool based on the best performing model was devised showing the probability of having sciatica based on results from
five clinical items (subjective sensory changes, below knee pain, leg pain worse than back pain, positive neural tension, neurological deficit). Latent class analysis identified five classes of LBLP patients. One class was clearly a referred leg pain group, the other four classes seemed to represent sciatica with varying clinical profiles.
This thesis provides a diagnostic tool for sciatica with potential application in clinical and research settings. It also reveals clusters of LBLP patients which could represent more homogenous groups amenable to different treatment approaches. This thesis has provided a strong basis for future work to further explore the clinical utility of the findings.

Item Type: Thesis (Doctoral)
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Lisa Bailey
Date Deposited: 04 May 2017 08:26
Last Modified: 04 May 2017 08:26
URI: http://eprints.keele.ac.uk/id/eprint/3344

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