Systematic review of the sensitivity, specificity and validity of the active straight leg raise test in low back pain

Abstract

Background The active straight leg raise test (ASLR) is a commonly used clinical diagnostic test in a heterogenous group of conditions classified as low back pain. It may be used in a battery of tests to obtain a clinical diagnosis or to aid in the assessment of motor control in the lumbopelvic hip complex in the sagittal plane. A few variations of the ASLR exist in the literature. There is therefore a need to analyse the literature to determine to the most appropriate clinical application and interpretation of the test as the incorrect and/or ineffective application of the ASLR may influence patient outcomes. Data sources A systematic review of PubMed, Google Scholar, Cochrane Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus. Study selection All electronic or paper, English articles, which possessed the required key indexing terms and represented randomised and non-randomised controlled study designs were included. Data extraction and synthesis The blind review of the 25 articles was conducted by three independent reviewers (nine reviewers in total) using the non-randomised controlled trials (NOS) and Liddle scales. This allowed the methodological rigour of the article to be ranked. This ranking was compared to a critical appraisal of the article in order to achieve an overall decision with regards to the contribution of the article to the level of evidence for ASLR test. Results The evaluations and combined evidence were then determined for the ASLR under the heading non-pregnancy related PGP, LBP, and LPP, and various lift heights <10cm, 10-30cm, 30-60cm, full available range of motion, and unspecified range of motion. Due to study design (observational), no study exceeded level 3 evidence. Conclusion The ASLR was found to have a valid face construct, but assertions made in relation to its constructed validity in non-pregnancy related LBP is limited and conflicting. It is unclear if a positive ASLR result is from failure form closure of the public symphysis or the SIJ and if motor control is a contributing factor or product of pain.