Back Pain: The History and Physical Examination-Reply

In Reply. —I thank Drs Abromovitz, Frazier, Kelleher, Rothschild, and Weintraub for their interest and comments. Their letters offer an opportunity to reemphasize several points, and my colleagues and I invite them all to join us in seeking better evidence regarding the accuracy and usefulness of the history and physical examination. There are several parallel but different ways to think about test accuracy, and different ones are being adopted by different generations of clinicians. None is inherently better than any other and some of the writers call attention to the advantages and disadvantages of various statistics. These points are discussed in greater detail by Sackett in his introductory article to the series on the rational clinical examination.¹

We are unaware of data on the reproducibility or validity of the tests proposed by Dr Abromovitz. Some recent studies challenge the role of facet joints as a common cause of back