ARTICLE IN PRESS
Manual Therapy 12 (2007) e1
Letter to the Editor
Letter to the Editor regarding a study titled ‘‘Diagnosis of
sacroiliac joint pain: Validity of individual provocation
tests and composite of tests’’
[Manual Therapy 10 (2005) 207–218]
To the Editors:
I always appreciate it when new evidence comes out
that may help clinicians detect when patients have
sacroiliac joint dysfunction. I am unsure however
whether this paper adds anything new to the existing
literature. The difficulty lies in the patient’s that were
selected for this study and their credibility as ‘‘trust-
worthy’’ respondents. The inherent problem of this
study is in choosing a patient population where
susceptibility bias is intrinsically possible. According to
Table 1 the mean duration of symptoms for this cohort
of patients was 42.1 months or over 3 years, the time off
work was nearly 18 months or one and a half years, and
1356-689X/$ - see front matter r 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.math.2006.07.018
www.elsevier.com/locate/math
finally the Roland-Morris pain questionnaire’s mean
score was about 76%! This data suggests a distorted
assembly and one that I could hardly have faith in when
trying to determine if an 80% subjective improvement in
pain reduction occurred after sacroiliac joint injection.
The target or intended patient population of this study
should resemble characteristics of low back pain
patients frequently seen in the clinic and not one that
is reminiscent of a cohort of workman’s compensation
or litigating patients.
I realize that there is no ‘‘perfect’’ study and I applaud
the authors for trying to help improve the diagnostic
accuracy of detecting sacroiliac joint dysfunction.
Best Regards,
Michael T. Cibulka
Maryville University, Program in Physical Therapy,
St. Louis, MO 63105, USA