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).
Design
Randomized controlled trial.
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.
Key Words
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Article info
Footnotes
Supported by the Foundation for Physical Therapy.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Air Force or 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.
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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.
