TY - JOUR
T1 - The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain
T2 - A preliminary report
AU - Van Dillen, Linda R.
AU - Sahrmann, Shirley A.
AU - Norton, Barbara J.
AU - Caldwell, Cheryl A.
AU - McDonnell, Mary Kate
AU - Bloom, Nancy
N1 - Funding Information:
From the Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO. Supported in part by the Foundation for Physical Therapy (grant no. 94R-03-N0R-02), and the National Institute of Child Health and Human Development, National Center for Medical Rehabilitation Research (grant no. 5-K01HD-01226-01A1). Presented, in part, at the Combined Sections Meeting of the American Physical Therapy Association, February 2000, New Orleans, LA. 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 author(s) or upon any organization with which the author(s) is/are associated. Correspondence to Linda R. Van Dillen, PhD, PT, Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, St. Louis, MO 63108-2212, e-mail: [email protected]. Reprints are not available. 0003-9993/03/8403-7346$30.00/0 doi:10.1053/apmr.2003.50010
PY - 2003/3/1
Y1 - 2003/3/1
N2 - Objective: To examine the effect on symptoms of modifying patient-preferred movements and alignments of the lumbar spine during patient examination. Design: Repeated-measures study in which patients with low back pain (LBP) participated in a standardized examination that included tests of symptoms with various movements and positions. Setting: Six university-affiliated outpatient physical therapy clinics and the local community. Participants: Five trained physical therapists examined a total of 185 patients (102 women, 83 men; mean age, 41.89±13.29y) with LBP. The majority of patients had multiepisode, chronic LBP. Interventions: Not applicable. Main Outcome Measures: The examination included tests of symptoms with various alignments and movements in several different positions. Seven tests were designated as primary tests. Tests that increased symptoms were followed immediately by a secondary test in which (1) patient-preferred lumbar spine movement was modified or (2) the lumbar spine was positioned in a neutral alignment. Patients reported the effect of the secondary test on symptoms relative to their symptoms with the primary test. Three responses were possible: symptoms increased, remained the same, or decreased. Results: Eighty-three percent of the patients reported an increase in symptoms with 1 or more of the 7 primary tests. Ninety-five percent who reported an increase in symptoms with at least 1 of the primary tests reported a decrease in symptoms with 1 or more of the 7 secondary tests. The majority of patients reported a decrease in symptoms when the spinal movement or alignment was modified for 6 of the 7 secondary tests. Conclusions: Modifying the symptom-provoking movements and alignments of the spine during symptom testing resulted in a decrease in symptoms for the majority of patients. Information about specific modifications that provide relief of LBP symptoms is important because it can be used to design a treatment program that focuses on training a patient to modify the same movements and alignments in their everyday activities.
AB - Objective: To examine the effect on symptoms of modifying patient-preferred movements and alignments of the lumbar spine during patient examination. Design: Repeated-measures study in which patients with low back pain (LBP) participated in a standardized examination that included tests of symptoms with various movements and positions. Setting: Six university-affiliated outpatient physical therapy clinics and the local community. Participants: Five trained physical therapists examined a total of 185 patients (102 women, 83 men; mean age, 41.89±13.29y) with LBP. The majority of patients had multiepisode, chronic LBP. Interventions: Not applicable. Main Outcome Measures: The examination included tests of symptoms with various alignments and movements in several different positions. Seven tests were designated as primary tests. Tests that increased symptoms were followed immediately by a secondary test in which (1) patient-preferred lumbar spine movement was modified or (2) the lumbar spine was positioned in a neutral alignment. Patients reported the effect of the secondary test on symptoms relative to their symptoms with the primary test. Three responses were possible: symptoms increased, remained the same, or decreased. Results: Eighty-three percent of the patients reported an increase in symptoms with 1 or more of the 7 primary tests. Ninety-five percent who reported an increase in symptoms with at least 1 of the primary tests reported a decrease in symptoms with 1 or more of the 7 secondary tests. The majority of patients reported a decrease in symptoms when the spinal movement or alignment was modified for 6 of the 7 secondary tests. Conclusions: Modifying the symptom-provoking movements and alignments of the spine during symptom testing resulted in a decrease in symptoms for the majority of patients. Information about specific modifications that provide relief of LBP symptoms is important because it can be used to design a treatment program that focuses on training a patient to modify the same movements and alignments in their everyday activities.
KW - Low back pain
KW - Outcome assessment (health care)
KW - Rehabilitation
KW - Spinal cord diseases
UR - http://www.scopus.com/inward/record.url?scp=0037336924&partnerID=8YFLogxK
U2 - 10.1053/apmr.2003.50010
DO - 10.1053/apmr.2003.50010
M3 - Article
C2 - 12638097
AN - SCOPUS:0037336924
SN - 0003-9993
VL - 84
SP - 313
EP - 322
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 3 SUPPL. 1
ER -