Limits...
Lumbar segmental instability: a criterion-related validity study of manual therapy assessment.

Abbott JH, McCane B, Herbison P, Moginie G, Chapple C, Hogarty T - BMC Musculoskelet Disord (2005)

Bottom Line: Only translation LSI was found to be significantly associated with R/CLBP (p < 0.05).Extension PPIVMs performed better than flexion PPIVMs, with slightly higher sensitivity (16%; CI 6-38%) resulting in a likelihood ratio for a positive test of 7.1 (95% CI 1.7 to 29.2) for translation LSI.Likelihood ratios resulting from positive test results were only moderate.

View Article: PubMed Central - HTML - PubMed

Affiliation: Clarity Clinical Research Consultants, New Zealand. haxby@claritygroup.co.nz

ABSTRACT

Background: Musculoskeletal physiotherapists routinely assess lumbar segmental motion during the clinical examination of a patient with low back pain. The validity of manual assessment of segmental motion has not, however, been adequately investigated.

Methods: In this prospective, multi-centre, pragmatic, diagnostic validity study, 138 consecutive patients with recurrent or chronic low back pain (R/CLBP) were recruited. Physiotherapists with post-graduate training in manual therapy performed passive accessory intervertebral motion tests (PAIVMs) and passive physiological intervertebral motion tests (PPIVMs). Consenting patients were referred for flexion-extension radiographs. Sagittal angular rotation and sagittal translation of each lumbar spinal motion segment was measured from these radiographs, and compared to a reference range derived from a study of 30 asymptomatic volunteers. Motion beyond two standard deviations from the reference mean was considered diagnostic of rotational lumbar segmental instability (LSI) and translational LSI. Accuracy and validity of the clinical assessments were expressed using sensitivity, specificity, and likelihood ratio statistics with 95% confidence intervals (CI).

Results: Only translation LSI was found to be significantly associated with R/CLBP (p < 0.05). PAIVMs were specific for the diagnosis of translation LSI (specificity 89%, CI 83-93%), but showed poor sensitivity (29%, CI 14-50%). A positive test results in a likelihood ratio (LR+) of 2.52 (95% CI 1.15-5.53). Flexion PPIVMs were highly specific for the diagnosis of translation LSI (specificity 99.5%; CI 97-100%), but showed very poor sensitivity (5%; CI 1-22%). Likelihood ratio statistics for flexion PPIVMs were not statistically significant. Extension PPIVMs performed better than flexion PPIVMs, with slightly higher sensitivity (16%; CI 6-38%) resulting in a likelihood ratio for a positive test of 7.1 (95% CI 1.7 to 29.2) for translation LSI.

Conclusion: This study provides the first evidence reporting the concurrent validity of manual tests for the detection of abnormal sagittal planar motion. PAIVMs and PPIVMs are highly specific, but not sensitive, for the detection of translation LSI. Likelihood ratios resulting from positive test results were only moderate. This research indicates that manual clinical examination procedures have moderate validity for detecting segmental motion abnormality.

Show MeSH

Related in: MedlinePlus

The central posteroanterior passive accessory intervertebral motion (PAIVM) test. The patient lies prone. The clinician contacts the spinous process of the target vertebra with the hypothenar eminence, and delivers a gradual posteroanteriorly directed force.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC1310529&req=5

Figure 1: The central posteroanterior passive accessory intervertebral motion (PAIVM) test. The patient lies prone. The clinician contacts the spinous process of the target vertebra with the hypothenar eminence, and delivers a gradual posteroanteriorly directed force.

Mentions: The physiotherapists assessed PAIVMs and PPIVMs, at each lumbar segment, nested within a comprehensive physical examination. PAIVMs consisted of postero-anterior central pressure applied to the spinous processes, with the patient lying prone [1,2] (figure 1). PPIVMs were assessed with the patient side-lying, and consisted of moving the patients' spine through sagittal forward-bending (flexion) and backward-bending (extension), while palpating between the spinous process of adjacent vertebrae to assess the motion taking place at each motion segment [1,2] (figures 2 &3). PAIVM ratings were assessed on a 3 point ordinal scale, with 0 indicating hypomobility, 1 indicating normal motion, and 2 indicating hypermobility. PPIVMs were rated on a 5 point ordinal scale, with 0 & 1 indicating hypomobility, normal anchored at 2, and 3 & 4 indicating hypermobility. While pain responses were assessed, they were recorded separately from the assessment of motion, and were not included in the analysis for this study, which was concerned only with the assessment of spinal motion. Consenting patients were referred to radiology for flexion-extension lateral radiographs.


Lumbar segmental instability: a criterion-related validity study of manual therapy assessment.

Abbott JH, McCane B, Herbison P, Moginie G, Chapple C, Hogarty T - BMC Musculoskelet Disord (2005)

The central posteroanterior passive accessory intervertebral motion (PAIVM) test. The patient lies prone. The clinician contacts the spinous process of the target vertebra with the hypothenar eminence, and delivers a gradual posteroanteriorly directed force.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1310529&req=5

Figure 1: The central posteroanterior passive accessory intervertebral motion (PAIVM) test. The patient lies prone. The clinician contacts the spinous process of the target vertebra with the hypothenar eminence, and delivers a gradual posteroanteriorly directed force.
Mentions: The physiotherapists assessed PAIVMs and PPIVMs, at each lumbar segment, nested within a comprehensive physical examination. PAIVMs consisted of postero-anterior central pressure applied to the spinous processes, with the patient lying prone [1,2] (figure 1). PPIVMs were assessed with the patient side-lying, and consisted of moving the patients' spine through sagittal forward-bending (flexion) and backward-bending (extension), while palpating between the spinous process of adjacent vertebrae to assess the motion taking place at each motion segment [1,2] (figures 2 &3). PAIVM ratings were assessed on a 3 point ordinal scale, with 0 indicating hypomobility, 1 indicating normal motion, and 2 indicating hypermobility. PPIVMs were rated on a 5 point ordinal scale, with 0 & 1 indicating hypomobility, normal anchored at 2, and 3 & 4 indicating hypermobility. While pain responses were assessed, they were recorded separately from the assessment of motion, and were not included in the analysis for this study, which was concerned only with the assessment of spinal motion. Consenting patients were referred to radiology for flexion-extension lateral radiographs.

Bottom Line: Only translation LSI was found to be significantly associated with R/CLBP (p < 0.05).Extension PPIVMs performed better than flexion PPIVMs, with slightly higher sensitivity (16%; CI 6-38%) resulting in a likelihood ratio for a positive test of 7.1 (95% CI 1.7 to 29.2) for translation LSI.Likelihood ratios resulting from positive test results were only moderate.

View Article: PubMed Central - HTML - PubMed

Affiliation: Clarity Clinical Research Consultants, New Zealand. haxby@claritygroup.co.nz

ABSTRACT

Background: Musculoskeletal physiotherapists routinely assess lumbar segmental motion during the clinical examination of a patient with low back pain. The validity of manual assessment of segmental motion has not, however, been adequately investigated.

Methods: In this prospective, multi-centre, pragmatic, diagnostic validity study, 138 consecutive patients with recurrent or chronic low back pain (R/CLBP) were recruited. Physiotherapists with post-graduate training in manual therapy performed passive accessory intervertebral motion tests (PAIVMs) and passive physiological intervertebral motion tests (PPIVMs). Consenting patients were referred for flexion-extension radiographs. Sagittal angular rotation and sagittal translation of each lumbar spinal motion segment was measured from these radiographs, and compared to a reference range derived from a study of 30 asymptomatic volunteers. Motion beyond two standard deviations from the reference mean was considered diagnostic of rotational lumbar segmental instability (LSI) and translational LSI. Accuracy and validity of the clinical assessments were expressed using sensitivity, specificity, and likelihood ratio statistics with 95% confidence intervals (CI).

Results: Only translation LSI was found to be significantly associated with R/CLBP (p < 0.05). PAIVMs were specific for the diagnosis of translation LSI (specificity 89%, CI 83-93%), but showed poor sensitivity (29%, CI 14-50%). A positive test results in a likelihood ratio (LR+) of 2.52 (95% CI 1.15-5.53). Flexion PPIVMs were highly specific for the diagnosis of translation LSI (specificity 99.5%; CI 97-100%), but showed very poor sensitivity (5%; CI 1-22%). Likelihood ratio statistics for flexion PPIVMs were not statistically significant. Extension PPIVMs performed better than flexion PPIVMs, with slightly higher sensitivity (16%; CI 6-38%) resulting in a likelihood ratio for a positive test of 7.1 (95% CI 1.7 to 29.2) for translation LSI.

Conclusion: This study provides the first evidence reporting the concurrent validity of manual tests for the detection of abnormal sagittal planar motion. PAIVMs and PPIVMs are highly specific, but not sensitive, for the detection of translation LSI. Likelihood ratios resulting from positive test results were only moderate. This research indicates that manual clinical examination procedures have moderate validity for detecting segmental motion abnormality.

Show MeSH
Related in: MedlinePlus