Diagnostic Utility of Clinical Tests for Spinal Dysfunction

Chad Cook

In clinical practice, physical therapists use spine-related tests and measures daily and frequently associate all tests equally. Use of diagnostic accuracy values such as sensitivity, specificity, and positive likelihood ratios has improved our ability to discriminate tests’ strengths. Recent advances in diagnostic accuracy research have allowed physical therapists to progress beyond simple unadjusted accuracy measures; to categorize tests and measures based on the tests’ strengths in the spectrum of differential diagnosis. Differential Diagnosis is designed to provide the beginning and experienced physical therapist with parameters for analyzing elements of differential diagnosis and Prognosis (e.g. diagnostic accuracy values, checklists for quality scores for tests and measures, and guidelines for accuracy of prognosis studies). The foci of this presentation include essential parameters for effective screening, differentiation, and confirmation of spine-related tests and measures, used by physiotherapists. Strengths and weakness of each test and measure are discussed and tests are either vilified or advocated depending on each test’s value. Upon completion, the learner will have knowledge of a battery of useful diagnostic tests (as well as those that have limited use) but most importantly, will have knowledge on how to critique study designs to determine future values of tests and measures.


  1. Cook C, Hegedus E. Orthopedic clinical special tests. Upper Saddle River; Prentice Hall: 2008.
  2. Jaeschke R, Meade M, Guyatt G, Keenan SP, Cook DJ. How to use diagnostic test articles in the intensive care unit: diagnosing weananability using f/vt. Crit Care Med. 1997;25:1514-1521.
  3. Garbuz et al. Classification systems in orthopaedics. J Am Acad Orthop Surg. 2002;10:290-297
  4. Obuchowski et al. Ten Criteria for Effective Screening. Am J Roent. 2001;176:1357-62
  5. Kleinstuck et al. Are structural abnormalities on MRI a contraindication to the successful conservative treatment of chronic nonspecific low back pain? Spine. 2006;31:2250-2257.
  6. Jarvik et al. Three-year incidence of low back pain in an initially asymptomatic Cohort. Spine. 2005;30:1541-8.

Click to read Chad Cook's biography

  • Visit the blog

Hosted by
  • Link to: Kinetic Control website
  • MACP logo
Administered and sponsored by
  • Manual Thearpy Journal Cover
  • Elsevier Logo