Diagnostic accuracy of technologies used in low back pain assessment - Thermography, triaxial dynamometry, spinoscopy, and clinical examination

Study Design. A prospective blind study compared three new technologies to assess back pain. Objective. To assess the diagnostic accuracy and comparability of thermography, triaxial dynamometry, and spinoscopy in the assessment of recent onset work-related low back pain. Summary of Background Data. The role of these technologies in assessing patients with low back pain is unproved. Methods. Forty-one patients with low back pain and 46 control subjects were assessed by each technology and by two clinical examiners blind to clinical status. Twenty patients were trained to simulate a healthy back without low back pain, and 50% of the control subjects were trained to simulate the presence of a low back pain disorder. Each technology was interpreted on two occasions by each of two readers. Results. Thermography performed significantly worse than did triaxial dynamometry, spinoscopy, and clinical examination. The diagnostic accuracy of the last three was similar, and inter-rater comparability did not differ significantly. Among simulators, the diagnostic accuracy of triaxial dynamometry and spinoscopy was significantly higher than that of clinical examination, although considerable inaccuracy remained in assessing individual subjects. Conclusions. The diagnostic accuracy of thermography in recent onset low back pain does not support its use. Among those simulating normality or low back pain, triaxial dynamometry and spinoscopy have greater diagnostic accuracy than does a single clinical evaluation. However, for an individual, the inaccuracy that remains limits the use of triaxial dynamometry or spinoscopy for diagnosis in recent onset low back pain.