Predicting Response to Motor Control Exercises and Graded Activity for Low Back Pain Patients: Preplanned Secondary Analysis of a Randomized Controlled Trial (original) (raw)
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Journal of Manipulative and Physiological Therapeutics, 2016
Objective: The aims of this study were (1) to investigate the relationship between clinical tests detecting spinal instability and the perceived pain and disability in nonspecific low back pain and (2) to investigate the relationship between endurance and instability tests. Methods: Four instability tests (aberrant movements, active straight leg raising, prone instability test, and passive lumbar extension test) and 2 endurance tests (prone bridge test [PBT] and supine bridge test [SBT]) were performed on 101 participants. Their results were compared with the Numerical Rating Scale and the Oswestry Disability Index evaluating pain and disability, respectively. Results: A low to moderate significant relationship between pain, disability, and all tests with the exception of PBT was observed. A low to moderate significant relationship between endurance tests and instability tests was also shown. The results of PBT and SBT were significantly related to the duration of symptoms (P = .0014 and P = .0203, respectively). Conclusion: The results of endurance and instability tests appear to be related to the amount of pain and the disability in nonspecific low back pain. The persistence of pain significantly reduces anterior and posterior core muscle endurance.
The relationship between instability tests , pain and disability in non-specific low back pain
2016
From the '70s until the '90s, in clinical trials aimed at studying the effects of conservative interventions in people with low back pain, participants were randomly allocated to different treatment groups without a preliminary assessment that went beyond symptoms localization. The initial assumption was that patients exhibiting similar symptoms localization should be considered as a unique group. Consequently, the effects of different interventions were similar and guidelines merely suggested “Stay active”. Since the '80s some physiotherapists began to develop a number of evaluation tests in order to identify specific subgroups among people with low back pain and develop targeted treatments for each subgroup. However, in the early 2000s, the Assessment Diagnosis Treatment Outcome (ASTO) model, developed by K. Spratt [1], stated that each step must be validated before proceeding to the next. This talk will:
International Journal of Sports Physical Therapy, 2021
Background Low back pain (LBP) is one of the most common complaints in individuals who seek medical care and is a leading cause of movement impairments. The Functional Movement Screen (FMS™) was developed to evaluate neuromuscular impairments during movement. However, the reliability and validity of the FMS™ have not yet been established for the LBP population because of a limitation of its original scoring system. Purpose The purposes of this study were to determine the reliability and validity of the FMS™ with a modified scoring system in young adults with and without LBP. The FMS™ scores were modified by assigning a zero score only when there was an increase in LBP during the FMS™, not simply for the presence of pain, as in the original FMS™ scoring system. Study Design: Reliability and validity study. Methods Twenty-two participants with LBP (8 males and 14 females, 26.7 ± 4.68 years old) and 22 age- and gender-matched participants without LBP (26.64 ± 4.20 years old) completed the study. Each participant performed the FMS™ once while being scored simultaneously and independently by two investigators. In addition, each participant’s FMS™ performance was video-recorded and then was scored by another two investigators separately. The video-recorded performance also was scored twice six weeks apart by the same investigator to determine intra-rater reliability. Results The results showed excellent inter-rater and intra-rater reliability of the FMS™ composite score with intraclass correlation coefficients ranging from 0.93 to 0.99 for both groups. In addition, the LBP group scored significantly lower than the group without LBP (p = 0.008). Conclusions The results indicate that the FMS™ is able to distinguish between individuals with and without LBP, and that it could be a useful test for clinicians to quantify movement quality and to assess movement restrictions in individuals with LBP. Levels of Evidence: 2b.
The Reproducibility of a Clinical Grading System of Motor Control in Patients with Low Back Pain
Journal of Manipulative and Physiological Therapeutics, 2007
Objective: Over the past decade, instrument and palpation methods for quantifying the activation and recruitment of the transversus abdominis and lumbar multifidus have been proposed. Palpation methods however have recently been described and therefore have been subjected to little evaluation. One such palpation method is the Wisbey-Roth grading system. The recruitment of the transversus abdominis and lumbar multifidus is assessed in a series of functional body positions and movements. The ability to recruit these muscles is quantified by assigning 1 of 6 defined grades. The purpose of this study was to investigate the reproducibility of this grading system. Methods: A total of 2 meetings and 3 pilot trials were held with raters before commencement of the study to establish an agreed grading system protocol. Interrater reproducibility was investigated using a Latin square repeated measures design. Thirty-four subjects (62% male and 38% female; age range, 15-70 years) with a history of low back pain participated. A total of 4 practicing physiotherapists and 1 sports medicine physician graded subjects using the Wisbey-Roth grading system protocol. Results: Pair-wise weighted κ values ranged from −0.01 (95% confidence interval [CI], −0.33 to 0.31) to 0.56 (95% CI, 0.25 to 0.87), with average weighted κ being 0.29. The intraclass correlation coefficient (2,1) was 0.30 (95% CI, 0.15 to 0.48), and the standard error of the measurement was 1.6 units. Conclusions: The Wisbey-Roth grading system shows fair to poor reproducibility between raters. Therefore, it should not be used to exchange meaningful information between clinicians. Recommendations are made for further research and toward improving its reproducibility. (J Manipulative Physiol Ther 2007;30:501-508)
European Spine Journal, 2007
Many of the existing low back pain (LBP) questionnaires of function and symptoms have a content of different domains of disability presented as a single sum score, making it difficult to derive changes within a specific domain. The present study describes the development of a clinically derived back-specific questionnaire incorporating both a functional limitation and a symptom scale, with a further subdivision of the symptom scale in separate indices for severity and temporal aspects. The aims of the study were to assess the overall reliability and validity of the new questionnaire, named the Profile Fitness Mapping questionnaire (PFM). A total of 193 chronic LBP patients answered the PFM together with five validated criterion questionnaires. For the internal consistency of the questionnaires, the three indices of the PFM had the highest Cronbach's alpha (0.90-0.95) and all items had item-total correlations above 0.2. The correlation coefficients between the PFM and the back-specific criterion questionnaires ranged between 0.61 and 0.83, indicating good concurrent criterion validity. The best discriminative ability between patients with different pain severities was demonstrated by the functional limitation scale of the PFM. Well centered score distribution with no patient's score at the floor or the ceiling level indicates that the PFM has the potential to detect the improvement or worsening of symptoms and functional limitations in chronic LBP patients. Classification according to the International Classification of Functioning, Disability and health (ICF) of WHO revealed a high degree of homogeneous item content of the symptom scale to the domain of impairments, and of the functional limitation scale to the domain of activity limitations. The present study suggests that the PFM has a high internal consistency and is a valid indicator of symptoms and functional limitations of LBP patients. It offers the combination of a composite total score and the possibility of evaluations within specific domains of disability. Complementary evaluation of test-retest reliability and responsiveness to change is warranted.
BMC Sports Science, Medicine and Rehabilitation, 2010
Background: The study was conducted to assess whether patient-specific functional impairment and experienced daily disability improved after treatment to address active movement control of the low back. Method: A prospective study was carried out in two outpatient physiotherapy practices in the German-speaking part of Switzerland. 38 patients (17 males and 21 females) suffering from non-specific low back pain (NSLBP) and movement control impairment were treated. The study participants had an average age of 45 ± 13 years, an average height of 170 ± 8 cm and an average weight of 73 ± 15 kg. Patients were assessed prior and post treatment. Treatment was aimed at improving movement control of the lumbar spine, pain and disability. Six physiotherapists treated each patient on average nine times (SD 4.6). Treatment effects were evaluated using a set of six movement control tests (MCT), patientspecific functional pain scores (PSFS) and a Roland and Morris disability questionnaire (RMQ). Means, standard deviations, confidence intervals and paired t-tests were calculated. The effect size (d) was based on the change between t1 (time prior intervention) and t2 (time post intervention) using a significance level of p < 0.05, with d > 0.8 being considered a large effect. Power calculations were performed for type I & II error estimation. Results: Movement control (MCT) showed a 59% improvement from 3.2 (max 6) to 1.3 positive tests (d = 1.3, p < 0.001), complaints (PSFS) decreased 41% from 5.9 points (max 10) to 3.5 (d = 1.3, p < 0.001), and disability (RMQ) decreased 43% from 8.9 to 5.1 points (d = 1.0, p < 0.001). Conclusions: The results of this controlled case series study, based on prior and post intervention, showed that movement control, patient specific functional complaints and disability improved significantly following specific individual exercise programs, performed with physiotherapeutic intervention. The results obtained warrant performance of a randomized controlled trial (RCT) to substantiate our findings.
Movement and stability dysfunction-contemporary developments* 1
Manual Therapy, 2001
A good understanding of the control processes used to maintain stability in functional movements is essential for clinicians who attempt to treat or manage musculoskeletal pain problems. There is evidence of muscle dysfunction related to the control of the movement system. There is a clear link between reduced proprioceptive input, altered slow motor unit recruitment and the development of chronic pain states. Dysfunction in the global and local muscle systems is presented to support the development of a system of classification of muscle function and development of dysfunction related to musculoskeletal pain. The global muscles control range of movement and alignment, and evidence of dysfunction is presented in terms of imbalance in recruitment and length between the global stability muscles and the global mobility muscles. Direction related restriction and compensation to maintain function is identified and related to pathology. The local stability muscles demonstrate evidence of failure of adequate segmental control in terms of allowing excessive uncontrolled translation or specific loss of cross-sectional area at the site of pathology. Motor recruitment deficits present as altered timing and patterns of recruitment. The evidence of local and global dysfunction allows the development of an integrated model of movement dysfunction.
BMC Musculoskeletal Disorders, 2012
Background: Practice guidelines recommend various types of exercise for chronic back pain but there have been few head-to-head comparisons of these interventions. General exercise seems to be an effective option for management of chronic low back pain (LBP) but very little is known about the management of a sub-acute LBP within subgroups. Recent research has developed clinical tests to identify a subgroup of patients with chronic non-specific LBP who have movement control dysfunction (MD). Method/Design: We are conducting a randomized controlled trial (RCT) to compare the effects of general exercise and specific movement control exercise (SMCE) on disability and function in patients with MD within recurrent sub-acute LBP. The main outcome measure is the Roland Morris Disability Questionnaire. Discussion: European clinical guideline for management of chronic LBP recommends that more research is required to develop tools to improve the classification and identification of specific clinical subgroups of chronic LBP patients. Good quality RCTs are then needed to determine the effectiveness of specific interventions aimed at these specific target groups. This RCT aims to test the hypothesis whether patients within a subgroup of MD benefit more through a specific individually tailored movement control exercise program than through general exercises.
Movement and stability dysfunction – contemporary developments
SUMMARY. A good understanding of the control processes used to maintain stability in functional movements is essential for clinicians who attempt to treat or manage musculoskeletal pain problems. There is evidence of muscle dysfunction related to the control of the movement system. There is a clear link between reduced proprioceptive input, altered slow motor unit recruitment and the development of chronic pain states. Dysfunction in the global and local muscle systems is presented to support the development of a system of classification of muscle function and development of dysfunction related to musculoskeletal pain. The global muscles control range of movement and alignment, and evidence of dysfunction is presented in terms of imbalance in recruitment and length between the global stability muscles and the global mobility muscles. Direction related restriction and compensation to maintain function is identified and related to pathology. The local stability muscles demonstrate evidence of failure of adequate segmental control in terms of allowing excessive uncontrolled translation or specific loss of cross-sectional area at the site of pathology. Motor recruitment deficits present as altered timing and patterns of recruitment. The evidence of local and global dysfunction allows the development of an integrated model of movement dysfunction.