TY - JOUR
T1 - The Influence of Centralization and Directional Preference on Spinal Control in Patients With Nonspecific Low Back Pain
T2 - Journal of Orthopaedic & Sports Physical Therapy
AU - Apeldoorn, A. T.
AU - van Helvoirt, H.
AU - Meihuizen, Hanneke
AU - Tempelman, F.R.H.
AU - Vandeput, D.
AU - Knol, D. L.
AU - Kamper, S. J.
AU - Ostelo, R. W.
N1 - M1 - 4 ISI Document Delivery No.: DH4PC Times Cited: 0 Cited Reference Count: 53 Apeldoorn, Adri T. Van Helvoirt, Hans Meihuizen, Hanneke Tempelman, Henk Vandeput, David Knol, Dirk L. Kamper, Steven J. Ostelo, Raymond W. International Mechanical Diagnosis and Therapy Research Foundation (IMDTRF) This work was funded by the International Mechanical Diagnosis and Therapy Research Foundation (IMDTRF). The authors declare that the IMDTRF did not play a role in the design or writing of the manuscript or the decision to submit for publication. The Institutional Scientific Review Board of the EMGO Institute for Health and Care Research (VU University Medical Center in Amsterdam, the Netherlands) approved the study. We presented our study protocol to the Medical Ethics Committee of the VU University Medical Center in Amsterdam, which concluded that no formal approval was required according to the Dutch Medical Research Involving Human Subjects Act (registration number 2013/16). The current study was registered in the Dutch trial registry at http://www.trialregister.nl/trialreg/index.asp (NTR4246). The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. 0 1 4 J O S P T ALEXANDRIA J ORTHOP SPORT PHYS
PY - 2016
Y1 - 2016
N2 - STUDY DESIGN: Prospective cohort, test-retest design. BACKGROUND: Directional preference (DP) with centralization (CEN) and DP without CEN are common pain-pattern responses assessed by Mechanical Diagnosis and Therapy (MDT). Although there is evidence that MDT can reduce pain and disability in the short term by treating the patient with direction-specific exercises concordant with the patient's DP, the mechanism responsible for this is unclear. OBJECTIVE: To determine whether clinical signs of impaired spinal control improve immediately after eliciting a DP-with-CEN response or a DP-without-CEN response in patients with nonspecific low back pain. METHODS: Participants underwent a standardized MDT assessment and were classified into the following pain-pattern subgroups: DP with CEN, DP without CEN, or no DP. Clinical signs of impaired spinal control were assessed pre-MDT assessment and post-MDT assessment by an independent examiner. Four spinal control tests were conducted: aberrant lumbar movements while bending forward, the active straight leg raise (ASLR) test, the Trendelenburg test, and the prone instability test. Differences in spinal control pre-MDT assessment and post-MDT assessment were calculated for the 3 pain-pattern subgroups and compared with chi-square tests. We hypothesized that a larger proportion of patients in the DP-with-CEN subgroup would exhibit improved spinal control than patients categorized as DP without CEN or no DP. RESULTS: Of 114 patients recruited, 51 patients (44.7%) were categorized as DP with CEN, 23 (20.2%) as DP without CEN, and 40 (35.1%) as no DP. Before MDT assessment, between 28.9% (Trendelenburg test) and 63.7% (ASLR test) of patients showed impaired spinal control. After MDT assessment, a larger proportion of patients in the DP-with-CEN subgroup (43%) showed improvement than those in the no-DP subgroup (7%) on aberrant lumbar movements (P=.02). Likewise, more patients in the DP-with-CEN subgroup (50%) improved on the ASLR test than those in the no-DP subgroup (8%, P
AB - STUDY DESIGN: Prospective cohort, test-retest design. BACKGROUND: Directional preference (DP) with centralization (CEN) and DP without CEN are common pain-pattern responses assessed by Mechanical Diagnosis and Therapy (MDT). Although there is evidence that MDT can reduce pain and disability in the short term by treating the patient with direction-specific exercises concordant with the patient's DP, the mechanism responsible for this is unclear. OBJECTIVE: To determine whether clinical signs of impaired spinal control improve immediately after eliciting a DP-with-CEN response or a DP-without-CEN response in patients with nonspecific low back pain. METHODS: Participants underwent a standardized MDT assessment and were classified into the following pain-pattern subgroups: DP with CEN, DP without CEN, or no DP. Clinical signs of impaired spinal control were assessed pre-MDT assessment and post-MDT assessment by an independent examiner. Four spinal control tests were conducted: aberrant lumbar movements while bending forward, the active straight leg raise (ASLR) test, the Trendelenburg test, and the prone instability test. Differences in spinal control pre-MDT assessment and post-MDT assessment were calculated for the 3 pain-pattern subgroups and compared with chi-square tests. We hypothesized that a larger proportion of patients in the DP-with-CEN subgroup would exhibit improved spinal control than patients categorized as DP without CEN or no DP. RESULTS: Of 114 patients recruited, 51 patients (44.7%) were categorized as DP with CEN, 23 (20.2%) as DP without CEN, and 40 (35.1%) as no DP. Before MDT assessment, between 28.9% (Trendelenburg test) and 63.7% (ASLR test) of patients showed impaired spinal control. After MDT assessment, a larger proportion of patients in the DP-with-CEN subgroup (43%) showed improvement than those in the no-DP subgroup (7%) on aberrant lumbar movements (P=.02). Likewise, more patients in the DP-with-CEN subgroup (50%) improved on the ASLR test than those in the no-DP subgroup (8%, P
U2 - https://doi.org/10.2519/jospt.2016.6158
DO - https://doi.org/10.2519/jospt.2016.6158
M3 - Article
C2 - 26813757
SN - 0190-6011
VL - 46
SP - 258
EP - 269
JO - Journal of Orthopaedic and Sports Physical Therapy
JF - Journal of Orthopaedic and Sports Physical Therapy
ER -