Abstract of The Week: Validation of a Clinical Test of Thoracolumbar Dissociation in Chronic Low Back Pain

Abstract: Validation of a Clinical Test of Thoracolumbar Dissociation in Chronic Low Back Pain

Authors: Edith Elgueta-Cancino, PT, MPhil1, Siobhan Schabrun, BPhysio (Hons), PhD2, Lieven Danneels, PT, PhD3, Wolbert van den Hoorn, PT, MSc1, Paul Hodges, BPhty (Hons), PhD1

Objective: Preliminary study of concurrent and discriminant validity of a clinical test of thoracolumbar dissociation.

Background Control deficits of back muscles and trunk movement are common in chronic/recurrent low back pain (LBP). A reliable clinical test to rate an individual’s ability to dissociate lumbopelvic movement from the thoracolumbar region has been described. This test rates the performance quality of 5 key aspects against criterion standards.

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Methods Concurrent validity was examined by comparison of clinical test scores (overall score and each individual criterion) against spine kinematics. Discriminant validity was evaluated by comparison of scores between pain-free controls and participants with LBP. A receiver operating characteristic curve was calculated to determine the optimal cutoff or score to differentiate between good and poor performers.

Results Concurrent validity was supported by the significant correlation between the total score and motion of the T5 vertebra relative to the S1 vertebra (P<.05). Scores for some (4 correlations of 14 measures) but not all individual criteria were correlated with the kinematic features that each criterion was expected to reflect. Discriminant validity was supported by higher test scores for pain-free controls than for participants with LBP after 2 minutes of training (P = .045). Scores of less than 5.5 were more prevalent in the LBP group (pretraining LBP versus control, 72% versus 35%; P = .008; posttraining LBP versus control, 48% versus 16%; P = .018).

Conclusion This preliminary study of concurrent and discriminant validity of the test provides a foundation to further investigate its utility to characterize thoracolumbar movement patterns in individuals with LBP. J Orthop Sports Phys Ther 2015;45(9):703–712. Epub 9 Jul 2015. doi:10.2519/jospt.2015.5590

Why Should you Care?

Lumbopelvic control is essential to advance patients with functional movements (lifting, squatting, sit to stand) during the rehabilitation process. The five criteria mentioned in the article are basic, simple to use in the clinic and easy to quantify.   The investigators have broken down the anterior-posterior tilt of the lumbar spine in sitting into five measureable components.

  • Criterion 1: Quality of Pelvic Motions – Direction with best quality
    1. Graded 0-3 based on performance.
  • Criterion 2: Control of Adjacent Regions – Directions with best quality
    1. Graded 0-3 based on performance.
  • Criterion 3: Directional preference
    1. Graded 0-2 based on performance.
  • Criterion 4: Breathing
    1. Graded 0-1 based on performance.
  • Criterion 5: Repetition (Based on 10 reps)
    1. Graded 0-1 based on performance.

The test is simple to perform and it appears the cut-off is a score of 5.5/10 being more prevalent in people with LBP. The early indications are that this is a quick and easy test to measure the neuromuscular control of your patients with low back pain, and their progress with rehabilitation.

Refer to the below reference for the initial investigation and details regarding this clinical test.

Man Ther. 2014 Oct;19(5):418-24. doi: 10.1016/j.math.2014.03.009. Epub 2014 Mar 30.

A clinical test of lumbopelvic control: development and reliability of a clinical test of dissociation of lumbopelvic and thoracolumbar motion.

Elgueta-Cancino E1, Schabrun S1, Danneels L2, Hodges P3.

Want more on the Lumbopelvic Spine? We have upcoming courses in San DiegoDenverBoston, Gaithersburg, MD, Berrien Springs, MI, Seattle, and New York!

-Terry Pratt, MS, PT, COMT, FAAOMPT

NAIOMT Faculty

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