The use of passive straight leg raising test: A survey of clinicians

Abstract

Introduction: Passive Straight Leg Raising Test (PSLRT) is one of the most commonly performed test in clinical practice. The purpose of this study was to survey the practice and interpretation of PSLRT amongst clinicians working in a tertiary care hospital. Methods: A 15 item questionnaire survey was developed covering various aspects of PSLRT. Orthopaedic surgeons (n=15), neurosurgeons (n=7) and physiotherapists (n=9) were identified as clinicians performing this test regularly and were approached to take part in the survey. Results: The PSLRT was used in all cases of back and leg pain by 68% and correctly performed by 30/31. There was a wide variation in the angle at which it was considered positive (median 45 degrees, range 10-90 degrees). Only 7/31 correctly recognised reproduction of leg pain as indicative of a positive PSLRT. The sitting /distraction SLRT and well leg / cross SLRT was performed only by 3/31 and 16/31 of clinicians respectively. 90% felt that a positive PSLRT suggested nerve root irritation and 57% thought it was due to stretch of dura and / or nerve root. 23/31 clinicians felt that PSLRT was useful or very useful and 90% reported that result of PSLRT would affect the way they treat a patient. Conclusions: PSLRT is widely used, correctly performed and felt to be useful in practice. But the interpretation of a positive test, understanding of its mechanism and use of variations is poor. There is a need to improve the interpretation and understanding of PSLRT amongst its users.