Table 1

Hamstring injury diagnosis: effectiveness of clinical tests and grading the quality of evidence

Clinical testsLikelihood ratio, (95% CI)Diagnostic effectiveness
HighModerateLow/very low
MRI used as reference standard
 Pain on trunk flexion51 LR+=1.48 (1.12 to 1.97)Moderate quality of evidence
LR−=0.37 (0.22 to 0.63)Moderate quality of evidence
 Pain on active knee flexion51 LR+=1.50 (0.91 to 2.49)High quality of evidence
LR−=0.78 (0.78 to 1.01)High quality of evidence
 Painful passive straight leg raise51 LR+=1.33 (1.04 to 1.70)Moderate quality of evidence
LR−=0.42 (0.23 to 0.74)Moderate quality of evidence
 Painful active knee extension51 LR+=1.33 (1.02 to 1.72)Moderate quality of evidence
LR−=0.48 (0.28 to 0.81)Moderate quality of evidence
 Painful resisted knee flexion 90°51 LR+=1.18 (0.99 to 1.41)Moderate quality of evidence
LR−=0.40 (0.19 to 0.87)Moderate quality of evidence
 Painful resisted knee flexion 30°51 LR+=1.13 (0.94 to 1.36)Moderate quality of evidence
LR−=0.55 (0.27 to 1.13)Moderate quality of evidence
 Active slump51 LR+=1.16 (0.59 to 2.28)Moderate quality of evidence
LR−=0.96 (0.79 to 1.16)Moderate quality of evidence
 Composite test*49 LR+=0.95 (0.89 to 1.02)Moderate quality of evidence
LR−=NA
US used as reference standard
 Taking off shoe test50 LR+=NA
LR−=0.00Very low quality of evidence
 Resisted range of motion test50 LR+=NA
LR−=0.39 (0.32 to 0.48)Very low quality of evidence
 Passive range of motion test50 LR+=NA
LR−=0.43 (0.35 to 0.52)Very low quality of evidence
 Active range of motion test50 LR+=NA
LR−=0.45 (0.38 to 0.54)Very low quality of evidence
  • *Passive straight leg raise, active knee extension, manual muscle testing, active slump; MRI; The diagnostic effectiveness of the positive (LR+) and negative (LR−) likelihood ratios are classified individually as: very low (LR+: 1 to 2; LR−: 0.5 to 1), low (LR+: >2 to 5; LR−: 0.2 to <0.5), moderate (LR+: >5 to 10; LR−: 0.1 to <0.2); high (LR+: >10; LR−: <0.1). NA (non-applicable); diagnositc effectiveness unknown

  • NA, non-applicable; US, ultrasonography.