Original article
Lumbar Spine Segmental Mobility Assessment: An Examination of Validity for Determining Intervention Strategies in Patients With Low Back Pain

Presented to the Fifth Interdisciplinary World Congress on Low Back and Pelvic Pain, November 13, 2004, Melbourne, Australia.
https://doi.org/10.1016/j.apmr.2005.03.028Get rights and content

Abstract

Fritz JM, Whitman JM, Childs JD. Lumbar spine segmental mobility assessment: an examination of validity for determining intervention strategies in patients with low back pain.

Objective

To examine the predictive validity of posterior-anterior (PA) mobility testing in a group of patients with low back pain (LBP).

Setting

Outpatient physical therapy clinics.

Participants

Patients with LBP (N=131; mean age ± standard deviation, 33.9±10.9y; range, 19–59y), and a median symptom duration of 27 days (range, 1–5941d). Patients completed a baseline examination, including PA mobility testing, and were categorized with respect to both hypomobility and hypermobility (present or absent), and treated for 4 weeks.

Intervention

Seventy patients were randomized to an intervention involving manipulation and 61 to a stabilization exercise intervention.

Main Outcome Measures

Oswestry Disability Questionnaire (ODQ) scores were collected at baseline and after 4 weeks. Three-way repeated measures analyses of variance (ANOVAs) were performed to assess the effect of mobility categorization and intervention group on the change on the ODQ with time. Number-needed-to-treat (NNT) statistics were calculated.

Results

Ninety-three (71.0%) patients were judged to have hypomobility present and 15 (11.5%) were judged with hypermobility present. The ANOVAs resulted in significant interaction effects. Pairwise comparisons showed greater improvements among patients receiving manipulation categorized with hypomobility present versus absent (mean difference, 23.7%; 95% confidence interval [CI], 5.1%–42.4%), and among patients receiving stabilization categorized with hypermobility present versus absent (mean difference, 36.4%; 95% CI, 10.3%–69.3%). For patients with hypomobility, failure rates were 26% with manipulation and 74.4% with stabilization (NNT=2.1; 95% CI, 1.6–3.5). For patients with hypermobility, failure rates were 83.3% and 22.2% for manipulation and stabilization, respectively (NNT=1.6; 95% CI, 1.2–10.2).

Conclusions

Patients with LBP judged to have lumbar hypomobility experienced greater benefit from an intervention including manipulation; those judged to have hypermobility were more likely to benefit from a stabilization exercise program.

Section snippets

Participants

This study involved subjects who were participants in an RCT.18 The purpose of the RCT was to validate a clinical prediction rule developed to identify patients with LBP likely to benefit from spinal manipulation. Subjects were randomized to receive manipulation plus a stabilization exercise intervention, or a stabilization exercise intervention alone. The purpose of this secondary analysis was to examine the relation between a preintervention judgment of PA mobility and the outcomes of the 2

Results

Of the 131 subjects participating in the trial, 93 (71.0%) and 15 (11.5%) were judged to have hypomobility and hypermobility present, respectively. The distribution of subjects with hypomobility or hypermobility did not differ between the intervention groups. Three subjects (2.3%, 1 in the manipulation plus stabilization exercise group, 2 in the stabilization exercise group) were judged to have both hypomobility and hypermobility. These subjects were included in each analysis. The initial,

Discussion

When examining the validity of examination procedures such as PA mobility testing, it is important to consider the therapeutic decisions being made based on the test results.35 Previous studies examining the validity of the PA mobility testing have focused on comparing judgments made from therapists’ assessment of PA mobility in humans with mechanical devices designed to quantify stiffness.36, 37, 38, 39, 40 The results of these studies have shown variable correlations between therapist and

Conclusions

To our knowledge, this is the first study to examine the validity of the PA segmental mobility assessment based on comparing judgments of segmental mobility with the interventions used and patient outcomes. In our study, subjects with LBP who were judged to have lumbar spine hypomobility experienced greater benefit from the manipulation plus stabilization intervention. Similarly, subjects who were judged to have lumbar hypermobility were more likely to benefit from a stabilization exercise

Acknowledgments

We thank the following physical therapists for their assistance with data collection: Kevin Johnson, Guy Majkowski, Maria West, Evan Kelley, David Browder, Mike Blowers, Sherri Morrow, Brian Langford, Jeff McGuire, Cory Middel, and Trevor Petrou.

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    Supported by the Foundation for Physical Therapy.

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    Copyright © 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.