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Lumbar spine segmental mobility assessment: an examination of validity for determining intervention strategies in patients with low back pain
Fritz JM, Whitman JM, Childs JD
Archives of Physical Medicine and Rehabilitation 2005 Sep;86(9):1745-1752
clinical trial
6/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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 +/- 10.9 y; range 19 to 59 y), and a median symptom duration of 27 days (range 1 to 5,941 d). 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% to 42.4%), and among patients receiving stabilization categorized with hypermobility present versus absent (mean difference 36.4%; 95% CI 10.3% to 69.3%). For patients with hypomobility, failure rates were 26% with manipulation and 74.4% with stabilization (NNT 2.1; 95% CI 1.6 to 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 to 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.

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