Execution
- 1Select the five SIJ provocation tests used in the van der Wurff multitest regimen.
- 2Perform the tests in a standardized way and record whether each reproduces familiar SIJ pain.
- 3Avoid counting vague pressure, stretch, or nonfamiliar discomfort as positive.
- 4Interpret the cluster as positive when 3 or more of 5 tests are positive.
- 5Combine the cluster result with history, lumbar screening, hip screening, and red-flag exclusion.
Positive outcome
The cluster is positive when 3 or more of the 5 provocation tests reproduce the patient’s familiar pain. A positive cluster supports SIJ pain as a likely contributor. A negative cluster reduces suspicion but does not completely exclude extra-articular pelvic pain sources.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| van der Wurff et al. (2006) — multitest diagnostic study | NA | 85 | 79 | 4.05 | 0.19 |
| van der Wurff et al. (2000) — systematic review | NA | NA | NA | NA | NA |
CommentVan der Wurff’s cluster is conceptually aligned with Laslett’s conclusion that combinations of provocation tests outperform single tests. The reference standard was intra-articular anesthetic block, so the cluster best identifies intra-articular SIJ pain rather than all pelvic girdle pain. It is high value because it is a validated multitest rule.
High Clinical Value