Archives of Physical Medicine and Rehabilitation
Volume 86, Issue 9 , Pages 1753-1762, September 2005

Preliminary Development of a Clinical Prediction Rule for Determining Which Patients With Low Back Pain Will Respond to a Stabilization Exercise Program

  • Gregory E. Hicks, PhD, PT

      Affiliations

    • Departments of Physical Therapy and Rehabilitation Science and Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD
    • Corresponding Author InformationCorrespondence to Gregory E. Hicks, PhD, PT, Dept of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 100 Penn St, Baltimore, MD 21201
    • ,
  • Julie M. Fritz, PhD, PT, ATC

      Affiliations

    • Division of Physical Therapy, University of Utah, Salt Lake City, UT
    • ,
  • Anthony Delitto, PhD, PT

      Affiliations

    • Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
    • ,
  • Stuart M. McGill, PhD

      Affiliations

    • Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.

Abstract 

Hicks GE, Fritz JM, Delitto A, McGill SM. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program.

Objective

To develop a clinical prediction rule to predict treatment response to a stabilization exercise program for patients with low back pain (LBP).

Design

A prospective, cohort study of patients with nonradicular LBP referred to physical therapy (PT).

Setting

Outpatient PT clinics.

Participants

Fifty-four patients with nonradicular LBP.

Intervention

A standardized stabilization exercise program.

Main Outcome Measure

Treatment response (success or failure) was categorized based on changes in the Oswestry Disability Questionnaire scores after 8 weeks.

Results

Eighteen subjects were categorized as treatment successes, 15 as treatment failures, and 21 as somewhat improved. After using regression analyses to determine the association between standardized examination variables and treatment response status, preliminary clinical prediction rules were developed for predicting success (positive likelihood ratio [LR], 4.0) and failure (negative LR, .18). The most important variables were age, straight-leg raise, prone instability test, aberrant motions, lumbar hypermobility, and fear-avoidance beliefs.

Conclusions

It appears that the response to a stabilization exercise program in patients with LBP can be predicted from variables collected from the clinical examination. The prediction rules could be used to determine whether patients with LBP are likely to benefit from stabilization exercises.

Key Words:  Classification , Exercise , Low back pain , Rehabilitation

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 Supported by the Foundation for Physical Therapy Clinical Research Center.The opinions and assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the U.S. Department of the Army or the Department of Defense.No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.Reprints are not available from the author.

PII: S0003-9993(05)00360-6

doi:10.1016/j.apmr.2005.03.033

Archives of Physical Medicine and Rehabilitation
Volume 86, Issue 9 , Pages 1753-1762, September 2005

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