Table 4.
Guideline recommendations for physical examination and other diagnostic procedures.
| Physical Examination | Guideline * | Consistency | Clinical Inference |
|---|---|---|---|
| Femoral stretch test | NASS | Inconsistent | None |
| NBPN | |||
| PARM | |||
| Straight leg test | NASS | Consistent | Should do |
| PARM | |||
| IHM | |||
| NHG | |||
| ACP-APS | |||
| NBPN | |||
| Crossed straight leg test | NASS | Consistent | Should do |
| PARM | |||
| IHM | |||
| NHG | |||
| NBPN | |||
| Muscle testing | NASS | Common/consistent | Should/Could do |
| PARM | |||
| IHM | |||
| NHG | |||
| ACP-APS | |||
| NBPN | |||
| Sensory testing | NASS | Common | Could do |
| PARM | |||
| IHM | |||
| ACP-APS | |||
| NBPN | |||
| Reflex tests (ankle and knee tendon) | PARM | Inconsistent | None |
| NBPN | |||
| ACP-APS | |||
| NASS | |||
| Mapping pain distribution | PARM | Consistent | Should do |
| IHM | |||
| Slump test | PARM | Inconsistent | None |
| NASS | |||
| Wasserman test | PARM | Consistent | Could do |
| IHM | |||
| Gait | PARM | Consistent | Should do |
| IHM | |||
| Agreement of signs and symptoms | PARM | Consistent | Should do |
| IHM | |||
| Diagnostics | |||
| Imaging | |||
| Routinely offering imaging in primary care or absent of red flags | KCE ICSI NICE ACOEM CCGI ACR NBPN |
Consistent | Do not do |
| Computed Tomography (CT)/ Magnetic resonance imaging (MRI) routinely in first 4–6 weeks | ICSI | Consistent | Do not do |
| ACOEM | |||
| NHG | |||
| PRSM | |||
| IHM NBPN |
|||
| CT when history and physical examination findings consistent with disc herniation, after 4–6 weeks of low back pain if surgery is considered, severe or progressive neurologic signs and symptoms present | NASS VA/Dod TOP PRAM ACOEM IHM ACP-APS NBPN ACR |
Consistent | Should do |
| MRI when history and physical examination findings consistent with disc herniation, radiculopathy persists after six weeks, if surgery is considered, severe or progressive neurologic signs and symptoms present, where an epidural glucocorticosteroid injection is being considered | NASS VA/DoD TOP NBHD EG PRAM ACOEM IHM ACP-APS UMHS NBPN ACR ACP |
Common | Should do |
| Others | |||
| EMG | EG PRAM ACOEM IHM UMHS |
Inconsistent | None |
| Sensory nerve somatosensory evoked potentials (SEP) | NASS DLE-DWC |
Inconsistent | None |
| Discography | ACOEM | Inconsistent | None |
| DLE-DWC | |||
| Diagnostic medial branch block | APS | Inconsistent | None |
| ACOEM |
* Table 1 provides the extensive names of the included guidelines.