New paper published!!

It is with great pleasure I announce that our new paper has been accepted for publication:

"Deneuville JP, Laslett M, Cervantes A, Peterlongo.P., Ounajm A, Artico R: Concurrent validity of the directional preference phenomenon compared to controlled lumbar discography: A supplementary analysis of a diagnostic accuracy study. Musculoskelet Sci Pract 2025, 80:10.

https://doi.org/10.1016/j.msksp.2025.103413

I am so grateful to JP Deneuville and collaborators for doing all the hard work of repeating data entry (double blind) of my data from 2001/2002, checking and cleaning, and doing the analysis and writing up. I had intended to publish results of our diagnostic accuracy study of directional preference in relation to controlled provocation discography in 2006 or 2007, but life got in the way after completing my PhD. Without JP and his team, this data would never have been properly presented and peer reviewed. Modern analysis techniques have revealed that directional preference has high specificity for painful lumbar discogenic pain i.e. is diagnostic of a subset of lumbar discogenic pain.

Here is the abstract:

"Background: Persistent low back pain (LBP) is a symptom with many potential causes. Centralisation phenomenon (CP) has emerged as promising diagnostic tools for identifying a subset of discogenic pain. CP represents a subgroup of patients demonstrating Directional Preference (DP) and to date the diagnostic accuracy of DP has never been assessed. To bridge this gap, this study evaluates the diagnostic accuracy of DP for discogenic pain, compares its properties to CP, and explores the development of clinical diagnostic rules (CDRs) for patients with negative testing for DP, or inability to undergo repeated movement testing.

Methods: 103 persistent low back pain patients were assessed by a physiotherapist to collect clinical data and determine DP status. Subsequently, a radiologist performed controlled discography to determine the discogenic pain status. Both the physiotherapist and the radiologist were blinded to each other’s findings.

Results: DP demonstrated high diagnostic accuracy (specificity: 0.94; Positive Likelihood Ratio (LR+): 7.65) but low screening properties (sensitivity: 0.48; Negative Likelihood Ratio (LR􀀀 ): 0.56). CP showed similar diagnostic properties (specificity: 0.94; LR+: 5.57). A CDR for untestable DP yielded low predictive power (Area Under the Curve (AUC): 0.57). Due to limited sample size and missing data, no valid CDR could be established to assist

diagnostic decision when DP is negative.

Conclusions: DP is a valid diagnostic tool for mechanical discogenic pain but has limited screening utility. Further studies are needed to refine diagnostic approaches and explore subgroups, such as those with Modic changes/inflammation-driven discogenic pain."