Time in Bed, Sleeping Difficulties, and Nutrition in Pregnant New Zealand Women.

We consider the relationship between time in bed (TIB) and sleeping difficulties with demographic variables and nutrient intakes in the second (T2) and third (T3) trimester of pregnancy. Data were acquired from a volunteer sample of New Zealand pregnant women. In T2 and T3, questionnaires were administered, diets were obtained from one 24 h recall and three weighed food records, and physical activity was measured with the use of three 24 h diaries. In total, 370 women had complete information in T2 and 310 in T3. In both trimesters, TIB was associated with welfare or disability status, marital status and age. In T2, TIB was associated with work, childcare, education and pre-pregnancy alcohol consumption. There were fewer significant lifestyle covariates in T3. In both trimesters, TIB declined with increasing dietary intake, especially water, protein, biotin, potassium, magnesium, calcium, phosphorus and manganese. Adjusted for weight of dietary intake and welfare/disability, TIB declined with increasing nutrient density of B vitamins, saturated fats, potassium, fructose and lactose; and TIB increased with carbohydrate, sucrose and vitamin E. Subjective sleeping difficulties increased with the week of gestation, morning sickness severity, anxiety, dairy and saturated fat intake, and they decreased with fruit, vegetable and monounsaturated fat intake. The study highlights the changing influence of covariates throughout the pregnancy and corroborates several published findings on the relationship of diet and sleep.

Maternal alcohol intakes before and during pregnancy: Impact on the mother and infant outcome to 18 months.

AIM: To investigate maternal alcohol intakes before and during pregnancy, their impact on mothers and infants to 18 months. METHOD: Prospective study of 504 New Zealand volunteers visited in months 4 and 7 of pregnancy, measurements taken, lifestyle details recorded including alcohol intake before and during pregnancy. Eighteen months after birth, 370 infants were measured, and infant development recorded. RESULTS: Nineteen per cent of mothers never drank, 53% stopped when they knew they were pregnant, 29% continued to drink. Twenty-two per cent of drinkers binge drank (over 50 g alcohol per session) before pregnancy and 10% during pregnancy. Daily drinking was associated with increased obesity in mothers. Alcohol consumption before or during pregnancy was not associated with infant motor development, had a slight negative effect on growth, and a significant association with vocal ability to 18 months. Energy intake appeared to partially moderate this effect. CONCLUSION: Maternal alcohol consumption exceeding 50 g per session both before and during pregnancy was associated with decreasing vocal ability in the 18-month old infant.

Consent and widespread access to personal health information for the delivery of care: a large scale telephone survey of consumers' attitudes using vignettes in New Zealand.

OBJECTIVES: In light of recent health policy, to examine factors which influence the public's willingness to consent to share their health information in a national electronic health record (EHR). DESIGN: Data were collected in a national telephone survey in 2008. Respondents were presented with vignettes that described situations in which their health information was shared and asked if they would consent to such sharing. The subset, consisting of the 18 vignettes that covered proving care, was reanalysed in depth using new statistical methods in 2016. SETTING: Adult population of New Zealand accessible by telephone landline. PARTICIPANTS: 4209 adults aged 18+ years in the full data set, 2438 of which are included in the selected subset. MAIN OUTCOME MEASURES: For each of 18 vignettes, we measured the percentage of respondents who would consent for their information to be shared for 2 groups; for those who did not consider that their records contained sensitive information, and for those who did or refused to say. RESULTS: Rates of consent ranged from 89% (95% CI 87% to 92%) for sharing of information with hospital doctors and nurses to 51% (47% to 55%) for government agencies. Mixed-effects logistic regression was used to identify factors which had significant impact on consent. The role of the recipient and the level of detail influenced respondents' willingness to consent (p<0.0001 for both factors). Of the individual characteristics, the biggest impact was that respondents whose records contain sensitive information (or who refused to answer) were less willing to consent (p<0.0001). CONCLUSIONS: A proportion of the population are reluctant to share their health information beyond doctors, nurses and paramedics, particularly when records contain sensitive information. These findings may have adverse implications for healthcare strategies based on widespread sharing of information. Further research is needed to understand and overcome peoples' ambivalence towards sharing their information.

The Relationship between Vitamin D Status and Allergic Diseases in New Zealand Preschool Children.

Recent research on vitamin D in young children has expanded from bone development to exploring immunomodulatory effects. Our aim was to investigate the relationship of vitamin D status and allergic diseases in preschool-aged children in New Zealand. Dried capillary blood spots were collected from 1329 children during late-winter to early-spring for 25(OH)D measurement by LC-MS/MS. Caregivers completed a questionnaire about their child's recent medical history. Analysis was by multivariable logistic regression. Mean 25(OH)D concentration was 52(SD19) nmol/L, with 7% of children <25 nmol/L and 49% <50 nmol/L. Children with 25(OH)D concentrations ≥75 nmol/L (n = 29) had a two-fold increased risk for parent-report of doctor-diagnosed food allergy compared to children with 25(OH)D 50-74.9 nmol/L (OR = 2.21, 1.33-3.68, p = 0.002). No associations were present between 25(OH)D concentration and presence of parent-reported eczema, allergic rhinoconjunctivitis or atopic asthma. Vitamin D deficiency was not associated with several allergic diseases in these New Zealand preschool children. In contrast, high 25(OH)D concentrations were associated with a two-fold increased risk of parental-report food allergy. This increase supports further research into the association between vitamin D status and allergic disease in preschool children.

Water and nutrient intake in pregnant New Zealand women: association with wheeze in their infants at 18 months.

The association between water and nutrient intake in pregnant women, and wheeze in their 18 month old infants, was investigated in a prospective study. Volunteers (n=369) recruited from northern New Zealand were visited in months 4 and 7 of pregnancy. At each visit anthropometric measurements were taken, diet assessed by 24-hour recall and 3-day food records and questionnaires determining personal details administered. Eighteen months after birth, infants were measured, and questions on infant feeding and wheeze asked. Overall, mothers reported 32% of their infants had wheezed in the last 12 months. After adjusting for significant covariates and energy intake, higher maternal intakes of dietary water (p=0.009) and manganese (p=0.024) were associated with decreased wheeze, and glucose (p=0.003) with increased wheeze. Prevalence of infant wheeze decreased 18.5% from the lower to the upper quartile of water intake, and 17.4% from the lower to the upper quartile of manganese intake. Wheeze was more common in Polynesian than European infants (41.8% vs 28.9%). Polynesian mothers consumed significantly less dietary water (median 451 g less) and manganese (median 1374 µg less) than European mothers per day. Glucose was only significant because of strong association with infant wheeze at extremely high maternal intakes of >40 g/day in ~10% of the subjects. There was no association between maternal dietary supplement intake and wheeze. Mothers estimated at high risk of infant wheeze consumed less tap water, whole grains, tea, fruit; and more fruit juice, soft drink, processed meat and fish products, and refined grain products. This is the first study to report an intergenerational association between maternal water, and glucose intake with infant wheeze.

Subcutaneous body fat in pregnant New Zealand women: association with wheeze in their infants at 18 months.

To investigate the association of subcutaneous body fat levels in pregnant women with wheezing in their 18 month old infants. A prospective study of European and Polynesian volunteers (n = 369) recruited from northern New Zealand were visited in months 4 and 7 of pregnancy when height, weight, and triceps, biceps and costal skinfolds were measured, and questionnaires determining personal details administered; and again visited 18 months after birth when infants were measured and questions on infant feeding and wheeze administered. At 18 months 32 % of infants had wheezed in the past 12 months. Increased wheeze was associated with maternal asthma, eczema or allergy (p = 0.001); receiving family welfare payments (p = 0.010); and being Polynesian (p = 0.021); while exclusive breastfeeding to 2 months (p = 0.045) was associated with decreased wheeze. Individual month 4 and month 7 mean triceps, biceps and costal skinfolds were all greater in mothers of wheezers compared to nonwheezers, biceps and costal skinfolds significantly so (p = 0.002, p = 0.005 at month 7). The sum of these skinfolds at month 4, at month 7, and the difference between these sums, were all significantly associated with increased risk of infant wheeze at 18 months when considered alone (p = 0.037, p = 0.001 and p = 0.015) or in combination. Prevalence of infant wheeze was 22.7 % for mothers with lower quartile month 7 skinfolds, compared to 45.0 % for mothers with upper quartile. After adjusting for significant covariates the difference in skinfolds had the strongest association (p = 0.003) followed by sum at month 4 (p = 0.074 or 0.003 depending on whether Polynesian ethnicity was included in the model). The sum of skinfolds declined between month 4 and month 7 in 34 % of women. Prevalence of wheeze was 19.2 % where the difference in mothers' skinfolds between month 4 and month 7 decreased by 10 mm or more and 41.7 % where the difference increased by 10 mm or more. Mean month 4 weights, BMI and sum of skinfolds were below average in the latter group. As the sum of month 4 or month 7 maternal skinfolds increased the prevalence of infant wheeze increased. In addition as the change in skinfolds between month 4 and month 7 became more positive the prevalence of infant wheeze increased. This study suggests for the first time that changes in subcutaneous fat during pregnancy are associated with prevalence of infant wheeze.

New Zealanders' attitudes towards access to their electronic health records: preliminary results from a national study using vignettes.

This project investigates public attitudes towards sharing confidential personal health information held in electronic health records (EHRs). The project uses computer assisted telephone interviewing (CATI) to conduct a quantitative national survey of the attitudes of New Zealanders towards access to their personal health information using vignettes. Respondents are presented with vignettes which describe ways in which their health information might be used, and asked about their attitude to and consent for each type of access. The project outcome will be a specification of requirements for an e-consent model meeting the needs of most New Zealanders, thus enabling the potential benefits of electronically sharing confidential health information from EHRs. This article presents preliminary results from the first 1828 respondents. Respondents were most willing to share their information for the purpose of providing care. However, removing their name and address greatly increased the acceptability of sharing information for other purposes.

Major influences on nutrient intake in pregnant New Zealand women.

OBJECTIVE: To investigate factors associated with maternal diet during pregnancy and rank these in order of influence using data from a prospective cohort of 196 pregnant women, aged between 18 and 35 years of mostly European origin. METHODS: Anthropometric measurements were taken, questionnaires administered and 16 days of weighed diet intakes recorded, eight in the fourth and eight in the seventh month of pregnancy. Twenty four hours activity records were kept for 3 days at these times. Factors investigated were education, age, occupational status, welfare dependence, smoking, number of children, morning sickness, activity level, height, weight, body mass index, and sum of skinfolds. RESULTS: Univariate analyses showed median weight of food and nutrient intakes were significantly lower in the less educated, the young, welfare dependants, smokers, and those who vomited during pregnancy. Almost all subjects had intakes of Vitamin D, folate, iron, and selenium below the estimated average requirement. Multivariate analyses of each nutrient against all predictors showed that in decreasing order of importance, education, maternal height, welfare dependence, smoking, and morning sickness had the greatest overall effect on the women's diets, mostly through their influence on energy intake. Age and number of children had less association with nutrient intake but along with education had a strong association with energy adjusted quality of diet. Weight and activity had weak associations with the quantity and quality of intake. After adjusting for energy intake, morning sickness ceased to be relevant. CONCLUSION: To maximize effectiveness, education, welfare dependence, smoking, morning sickness, age, and parity are important factors to consider when attempting to change maternal diet during pregnancy.

Activity levels in pregnant New Zealand women: relationship with socioeconomic factors, well-being, anthropometric measures, and birth outcome.

Activity during pregnancy has health implications for mother and child. The aim of this prospective cohort study was to examine changes in activity levels during pregnancy; the influence of socioeconomic factors and well-being on activity, and the influence of activity on maternal anthropometric measures and birth outcome. Twenty-four hour activity diaries were collected for 3 d in months 4 and 7 of pregnancy in 197 volunteers. Anthropometric measures and questionnaires to determine personal details were collected at these times and 2 months post-partum. Health records were used to supply infant measures. The time spent on each activity category was calculated, and used to calculate overall daily metabolic equivalents (METs). Low socioeconomic (SES) group 24 h activity levels were significantly higher than for high SES or welfare groups (p = 0.013). Activity declined throughout pregnancy in all groups (p = 0.002). Women with children had higher 24 h activity, spending 41% more time walking and (or) on housework than nulliparous women (p = 0.013). Reduced well-being was associated with lower levels of activity. Sleep and lying down time influenced 2 month post-partum body mass (upper quartile gained 2.54 kg, lower quartile lost 0.24 kg, p < 0.001). Mean infant gestational age increased with increasing 24 h activity (p = 0.047). No infants were born prematurely to mothers who spent more than 190 min/d walking or doing housework activities in month 4. Probability of infant admission to the neonatal intensive care unit (NICU) declined with time spent walking or doing housework in month 4 (p = 0.007). Mean (SE) birth weight was 3883 (+/-165) g in the 10% of women spending less than 530 min sleeping or lying down per day, compared with 3413 (+/-104) g in the 10% of women spending 725 min or more sleeping or lying down. Socioeconomic factors were therefore important influences on activity levels during pregnancy. Inactivity, especially in early pregnancy, was associated with more maternal weight retention at 2 months post-partum and a greater probability of admission to NICU and premature delivery.

Clinical predictors of screening lumbar zygapophyseal joint blocks: development of clinical prediction rules.

BACKGROUND: Only controlled intra-articular zygapophyseal joint (ZJ) injections or medial branch blocks can diagnose ZJ-mediated low back pain. The low prevalence of ZJ pain implies that identification of clinical predictors of a positive response to a screening block is needed. PURPOSE: To estimate the predictive power of clinical findings in relation to pain reduction after screening ZJ blocks. STUDY DESIGN: As part of a wider prospective blinded study investigating diagnostic accuracy of clinical variables, a secondary analysis was carried out to seek evidence of variables potentially valuable as predictors of screening ZJ block outcomes. PATIENT SAMPLE: Chronic low back pain patients received screening ZJ blocks (n=151) with 120 patients included in the analysis after exclusions. OUTCOME MEASURES: Pain intensity was measured using a 100-mm visual analog scale, and responses were categorized according to 75% through 95% or more pain reduction in 5% increments. METHODS: Patients completed pain drawings, questionnaires, and a clinical examination before screening lumbar ZJ blocks. History, demographic and clinical variables were evaluated in cross tabulation and regression analyses with diagnostic accuracy values calculated for variables and variable clusters in relation to different pain reduction standards. RESULTS: At the 75% pain reduction standard, 24.5% responded to screening ZJ blocks and 10.8% responded at the 95% standard. The centralization phenomenon is not associated with pain reduction using any standard. No variables were useful predictors of post-ZJ block pain reduction of less than 90%. Seven clinical findings were associated with 95% pain reduction after blocks. Five useful clinical prediction rules (CPRs) were found for ruling out a 95% pain reduction (100% sensitivity), and one CPR had a likelihood ratio of 9.7, producing a fivefold improvement in posttest probability. CONCLUSIONS: A negative extension rotation test, the centralization phenomenon, and four CPRs effectively rule out pain ablation after screening ZJ block. One CPR generates a fivefold improvement in posttest probability of a negative or positive response to ZJ block.

Clinical predictors of lumbar provocation discography: a study of clinical predictors of lumbar provocation discography.

Discography is the only available method of directly challenging the discs for pain sensitivity. However, it is invasive, expensive and there is a debate about its clinical value. There is a need to identify clinical signs that may indicate the need for a discography examination. Pain centralization (retreat of referred pain to towards the spinal midline) has been associated with positive discography and possesses specificity between 80 and 100% depending on levels of disablement and psychosocial distress. Less than half of positive discography patients reports centralization and there is a need to identify other potentially valuable predictors. This study estimated the diagnostic accuracy of clinical variables in relation to provocation discography. In a blinded, prospective reference standard design in a private interventional radiology clinic, chronic low back patients received a detailed clinical examination followed by discography. Patients were typically disabled with high levels of psychosocial distress. Logistic regression modelling identified potentially useful clinical variables, and sensitivity, specificity and likelihood ratios were calculated for promising specific variables and combinations of variables. Of 118 consecutive discography cases, 107 had unconfounded data on discography results. History of persistent pain between acute episodes, a significant loss of extension and a subjective report of 'vulnerability' in what is termed as the 'neutral zone' had specificities of 83-92% and likelihood ratios between 2.0 and 4.1. Two combinations of variables were highly specific to positive discography, but no suitable screening test useful for ruling out positive discography was established. Three clinical variables have modest predictive power in relation to lumbar discography results and two combinations of variables were highly specific to positive discography.

Changing blood transfusion practice in elective joint arthroplasty: a nursing initiative.

The use of re-infusion drains on 99 consecutive patients undergoing total knee arthroplasty surgery at a large hospital was analysed. As a control group the records of 99 patients treated without re-infusion were analysed retrospectively. The primary aim was to ascertain the cost effectiveness of the drains. Secondary aims were to assess safety of the drains, whether or not they reduced the need for allogeneic blood transfusion and whether they decreased the length of stay in hospital. The direct cost of consumables increased for the evaluation period. There was a smaller proportion of allogeneic blood transfusion (27% vs 38%) and a smaller mean number of units transfused (0.92 vs 0.54) in the re-infusion group compared to the control group. Patients benefited directly in that the mean length of stay was also significantly shorter in the re-infusion group. We anticipate more direct cost saving with experience and best practice and conclude that the use of re-infusion drains is a cost effective blood saving method in total knee joint arthroplasty.

Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power.

BACKGROUND CONTEXT: The "centralization phenomenon" (CP) is the progressive retreat of referred pain towards the spinal midline in response to repeated movement testing (a McKenzie evaluation). A previous study suggested that it may have utility in the clinical diagnosis of discogenic pain and may assist patient selection for discography and specific treatments for disc pain. PURPOSE: Estimation of the diagnostic predictive power of centralization and the influence of disability and patient distress on diagnostic performance, using provocation discography as a criterion standard for diagnosis, in chronic low back pain patients. STUDY DESIGN/SETTING: This study was a prospective, blinded, concurrent, reference standard-related validity design carried out in a private radiology clinic specializing in diagnosis of chronic spinal pain. PATIENT SAMPLE: Consecutive patients with persistent low back pain were referred to the study clinic by orthopedists and other medical specialists for interventional radiological diagnostic procedures. Patients were typically disabled and displayed high levels of psychosocial distress. The sample included patients with previous lumbar surgery, and most had unsuccessful conservative therapies previously. DIAGNOSIS: results of provocation discography. INDEX TEST: The CP. Psychometric evaluation: Roland-Morris, Zung, Modified Somatic Perception questionnaires, Distress Risk Assessment Method, and 100-mm visual analog scales for pain intensity. METHODS: Patients received a single physical therapy examination, followed by lumbar provocation discography. Sensitivity, specificity, and likelihood ratios of the CP were estimated in the group as a whole and in subgroups defined by psychometric measures. RESULTS: A total of 107 patients received the clinical examination and discography at two or more levels and post-discography computed tomography. Thirty-eight could not tolerate a full physical examination and were excluded from the main analysis. Disability and pain intensity ratings were high, and distress was common. Sensitivity, specificity, and positive likelihood ratios for centralization observed during repeated movement testing for pain distribution and intensity changes were 40%, 94%, and 6.9 respectively. In the presence of severe disability, sensitivity, specificity, and positive likelihood ratios were 46%, 80%, 3.2 and for distress, 45%, 89%, 4.1. In the subgroups with moderate, minimal, or no disability, sensitivity and specificity were 37%, 100% and for no or minimal distress 35%, 100%. CONCLUSIONS: Centralization is highly specific to positive discography but specificity is reduced in the presence of severe disability or psychosocial distress.

Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests.

Previous research indicates that physical examination cannot diagnose sacroiliac joint (SIJ) pathology. Earlier studies have not reported sensitivities and specificities of composites of provocation tests known to have acceptable inter-examiner reliability. This study examined the diagnostic power of pain provocation SIJ tests singly and in various combinations, in relation to an accepted criterion standard. In a blinded criterion-related validity design, 48 patients were examined by physiotherapists using pain provocation SIJ tests and received an injection of local anaesthetic into the SIJ. The tests were evaluated singly and in various combinations (composites) for diagnostic power. All patients with a positive response to diagnostic injection reported pain with at least one SIJ test. Sensitivity and specificity for three or more of six positive SIJ tests were 94% and 78%, respectively. Receiver operator characteristic curves and areas under the curve were constructed for various composites. The greatest area under the curve for any two of the best four tests was 0.842. In conclusion, composites of provocation SIJ tests are of value in clinical diagnosis of symptomatic SIJ. Three or more out of six tests or any two of four selected tests have the best predictive power in relation to results of intra-articular anaesthetic block injections. When all six provocation tests do not provoke familiar pain, the SIJ can be ruled out as a source of current LBP.

Agreement between diagnoses reached by clinical examination and available reference standards: a prospective study of 216 patients with lumbopelvic pain.

BACKGROUND: The tissue origin of low back pain (LBP) or referred lower extremity symptoms (LES) may be identified in about 70% of cases using advanced imaging, discography and facet or sacroiliac joint blocks. These techniques are invasive and availability varies. A clinical examination is non-invasive and widely available but its validity is questioned. Diagnostic studies usually examine single tests in relation to single reference standards, yet in clinical practice, clinicians use multiple tests and select from a range of possible diagnoses. There is a need for studies that evaluate the diagnostic performance of clinical diagnoses against available reference standards. METHODS: We compared blinded clinical diagnoses with diagnoses based on available reference standards for known causes of LBP or LES such as discography, facet, sacroiliac or hip joint blocks, epidurals injections, advanced imaging studies or any combination of these tests. A prospective, blinded validity design was employed. Physiotherapists examined consecutive patients with chronic lumbopelvic pain and/or referred LES scheduled to receive the reference standard examinations. When diagnoses were in complete agreement regardless of complexity, "exact" agreement was recorded. When the clinical diagnosis was included within the reference standard diagnoses, "clinical agreement" was recorded. The proportional chance criterion (PCC) statistic was used to estimate agreement on multiple diagnostic possibilities because it accounts for the prevalence of individual categories in the sample. The kappa statistic was used to estimate agreement on six pathoanatomic diagnoses. RESULTS: In a sample of chronic LBP patients (n = 216) with high levels of disability and distress, 67% received a patho-anatomic diagnosis based on available reference standards, and 10% had more than one tissue origin of pain identified. For 27 diagnostic categories and combinations, chance clinical agreement (PCC) was estimated at 13%. "Exact" agreement between clinical and reference standard diagnoses was 32% and "clinical agreement" 51%. For six pathoanatomic categories (disc, facet joint, sacroiliac joint, hip joint, nerve root and spinal stenosis), PCC was 33% with actual agreement 56%. There was no overlap of 95% confidence intervals on any comparison. Diagnostic agreement on the six most common patho-anatomic categories produced a kappa of 0.31. CONCLUSION: Clinical diagnoses agree with reference standards diagnoses more often than chance. Using available reference standards, most patients can have a tissue source of pain identified.

Zygapophysial joint blocks in chronic low back pain: a test of Revel's model as a screening test.

BACKGROUND: Only controlled blocks are capable of confirming the zygapophysial joints (ZJ) as the pain generator in LBP patients. However, previous workers have found that a cluster of clinical signs ("Revel's criteria"), may be valuable in predicting the results of an initial screening ZJ block. It was suggested that these clinical findings are unsuitable for diagnosis, but may be of value in selecting patients for diagnostic blocks of the lumbar ZJ's. To constitute evidence in favour of a clinical management strategy, these results need confirmation. This study evaluates the utility of 'Revel's criteria' as a screening tool for selection of chronic low back pain patients for controlled ZJ diagnostic blocks. METHODS: This study utilized a prospective blinded concurrent reference standard related validity design. Consecutive chronic LBP patients completed pain drawings, psychosocial distress and disability questionnaires, received a clinical examination and lumbar zygapophysial blocks. Two reference standards were evaluated simultaneously: 1. 75% reduction of pain on a visual analogue scale (replication of previous work), and 2. abolition of the dominant or primary pain. Using "Revel's criteria" as predictors, logistic regression analyses were used to test the model. Estimates of sensitivity, specificity, predictive values and likelihood ratios for selected variables were calculated for the two proposed clinical strategies. RESULTS: Earlier results were not replicated. Sensitivity of "Revel's criteria" was low sensitivity (<17%), and specificity high (approximately 90%). Absence of pain with cough or sneeze just reached significance (p = 0.05) within one model. CONCLUSIONS: "Revel's criteria" are unsuitable as a clinical screening test to select chronic LBP patients for initial ZJ blocks. However, the criteria may have use in identifying a small subset (11%) of patients likely to respond to the initial block (specificity 93%).

Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests.

Research suggests that clinical examination of the lumbar spine and pelvis is unable to predict the results of diagnostic injections used as reference standards. The purpose of this study was to assess the diagnostic accuracy of a clinical examination in identifying symptomatic and asymptomatic sacroiliac joints using double diagnostic injections as the reference standard. In a blinded concurrent criterion-related validity design study, 48 patients with chronic lumbopelvic pain referred for diagnostic spinal injection procedures were examined using a specific clinical examination and received diagnostic intraarticular sacroiliac joint injections. The centralisation and peripheralisation phenomena were used to identify possible discogenic pain and the results from provocation sacroiliac joint tests were used as part of the clinical reasoning process. Eleven patients had sacroiliac joint pain confirmed by double diagnostic injection. Ten of the 11 sacroiliac joint patients met clinical examination criteria for having sacroiliac joint pain. In the primary subset analysis of 34 patients, sensitivity, specificity and positive likelihood ratio (95% confidence intervals) of the clinical evaluation were 91% (62 to 98), 83% (68 to 96) and 6.97(2.70 to 20.27) respectively. The diagnostic accuracy of the clinical examination and clinical reasoning process was superior to the sacroiliac joint pain provocation tests alone. A specific clinical examination and reasoning process can differentiate between symptomatic and asymptomatic sacroiliac joints