The Active Straight Leg Raise test in lumbopelvic pain during pregnancy

Although many properties of the Active Straight Leg Raise (ASLR) test as a diagnostic test in lumbopelvic pain (LPP) are well documented, various elements are lacking. A cross-sectional study was performed to compute sensitivity and specificity, to assess the advantages and disadvantages of various cutoff points, to analyze the relation between the ASLR test and the Posterior Pelvic Pain Provocation (PPPP) test, and to investigate the relation with confounders. Data of 110 women with LPP and 72 without LPP were available. The advantages and disadvantages of four cutoff points of ASLR, and combinations of the ASLR and PPPP, were investigated by comparing sensitivity, specificity and area under the curves (AUC) of receiver operating characteristic curves (ROC). The influence of the site of pain was analyzed by means of AUC. The relation with confounders was measured using Pearson correlation coefficients. Results show that for diagnostic use the best cutoff for the ASLR test in pregnancy is between score 0 and 1. Specificity of the ASLR test is good (88%). Sensitivity for all types of LPP during pregnancy is moderate (54%), and is larger in case of more pain and disability. When combined with the PPPP test, sensitivity of the ASLR test is larger (68%). Isolated symphyseal pain, isolated low back pain and isolated coccyx pain are not diagnosed by these two tests. The ASLR test is not influenced by age, number of previous deliveries, BMI, cause of LPP (pregnancy-related or not), the existence of urinary incontinence and/or level of fatigue