The importance of developing evidence-based clinical examinations for low back pain

Low back pain (LBP) is the number one cause of years lived with disability in the world. Approximately 80% of people experience LBP at least once in their lifetime and many of them remain to have LBP at older ages. Despite the high prevalence of LBP, approximately 90% of LBP are labelled as non-speci ̄c LBP because no clear etiologies can be found. Given that medical imaging has limited values in diagnosing patients with LBP, lumbar imaging is recommended only when serious pathologies (e.g., malignancy, fracture, infection) are suspected. In order to prescribe treatments for patients with LBP, physical therapists need to rely on patient history and clinical examinations to inform clinical decisions. In the absence of robust evidence or knowledge on the assessment criteria for identifying patients with di®erent underlying causes of non-speci ̄c LBP, a Delphi process is commonly used to solicit expert opinions regarding the most appropriate assessment criteria for classifying patients into di®erent subgroups for treatment allocations. Following the Delphi process, further studies should be conducted to evaluate the clinimetric properties of the recommended assessment criteria. Since some clinical examinations initially thought to be useful for di®erentiating di®erent patient subgroups for treatment allocations may display suboptimal clinical values in some patient populations later, any clinical examinations derived from the Delphi process must be evaluated thoroughly before applying them in clinical practice. In this issue of Hong Kong Physiotherapy Journal, Vongsirinavarat and co-workers conducted a single-group, repeated measures reliability study to evaluate the agreement of two experienced physical therapists in using nine assessment criteria derived from a Delphi study to diagnose patients with lumbar facet joint pain in a clinical setting. Speci ̄cally, the assessment criteria include three subjective assessments (i.e., localized unilateral pain, referred pain above knee, and no radicular pain), three movement tests (i.e., pain reduction in °exion, pain in extension, and pain in extension with side °exion and rotation