Clinical tests of the sacroiliac joint

In the literature many tests are described which are designed to provoke pain or detect joint mobility in the sacroiliac joint (SIJ). However, in part 1 of this review, the authors stated that there is little evidence of reliability of these tests. In this article, the authors describe the methodological review of 11 studies, which have dealt with the validity of SIJ tests. The methodological quality of the studies was tested by using a list of criteria that consisted of three categories: 1) study population, 2) test procedure and 3) test results. A weighting for each criterion was developed. The methodological score for the studies was, in general, disappointing and looked promising for only two out of 11 studies (58 and 64 points). Four authors drew conclusions of positive validity from the tests they studied but other authors did not confirm these results. The conclusion of this methodological review is that there is no evidence to support the inclusion of mobility and pain provocation tests for the SIJ in clinical practice. Three major problems have been identified in validating SIJ dysfunction tests. Firstly, poor reliability of SIJ dysfunction tests exists, which may be improved by multiple test scores as postulated in part 1 of this review. Secondly, the methodological quality of validity studies needs to be developed to a much higher level with special consideration paid to sensitivity, specificity, confidence intervals and likelihood ratio values. And finally, there is a need for the proper use of a gold standard in assessing the validity of SIJ tests.