TY - JOUR AU - Knol D. AU - Apeldoorn A. AU - Ostelo R. AU - Kamper S. AU - van Helvoirt H. AU - Meihuizen H. AU - Tempelman H. AU - Vandeput D. AB -

Study Design Prospective cohort, test-retest design. Background DP/CEN and DP/non-CEN are common pain pattern responses assessed by Mechanical Diagnosis & 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 if clinical signs of impaired spinal control improve immediately after eliciting a directional preference with centralization response (DP/CEN), or a directional preference without centralization response (DP/non-CEN), in patients with nonspecific low back pain (LBP). Methods Participants underwent a standardized MDT assessment and were classified in a pain pattern subgroup; DP/CEN, DP/non-CEN, or no-DP. Clinical signs of impaired spinal control were assessed pre- 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- and post-MDT assessment were calculated for the three pain pattern subgroups and compared with Chi-square tests. We hypothesized that a larger proportion of patients in the DP/CEN subgroup would improve on spinal control than patients categorized as DP/non-CEN or no-DP. Results Of 114 patients recruited, 51 patients (44.7%) were categorized as DP/CEN, 23 (20.2%) as DP/non-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/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/CEN subgroup (50%) improved on the ASLR test than in the no-DP subgroup (8%, P < .01) or the DP/non-CEN subgroup (7%, P = .01). Changes in Trendelenberg and prone instability tests did not reach statistical significance. Conclusions Immediately following MDT assessment, a larger proportion of patients with a DP/CEN pain pattern showed improvement in clinical signs of spinal control compared to patients with a DP/non-CEN or no-DP pain pattern. Level of Evidence 2b. J Orthop Sports Phys Ther, Epub 26 Jan 2016. doi:10.2519/jospt.2016.6158.

AD - Postdoctoral researcher, Department of Epidemiology and Biostatistics and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands & Physical Therapist, Rehabilitation department, Medical Centre Alkmaar, Alkmaar, the Netherlands.
Physical Therapist, Medical Back Neck Centre, The Hague, the Netherlands.
Physical Therapist, Rugpoli, Delden, the Netherlands.
Physical Therapist, McKenzie Clinic Limburg, Maasmechelen, Belgium.
Assistant Professor of Statistics, Department of Epidemiology and Biostatistics and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.
Research fellow, Department of Epidemiology and Biostatistics and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands & The George Institute, University of Sydney, Sydney, Australia.
Professor, Department of Epidemiology and Biostatistics and the EMGO+ Institute for Health and Care Research, VU University Medical Centre & Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, the Netherlands. AN - 26813757 BT - Journal of Orthopaedic and Sports Physical Therapy DA - 93562401117 DP - NLM ET - 2016/01/28 LA - Eng LB - AUS
MSK
FY16 N1 - Apeldoorn, Adri T
van Helvoirt, Hans
Meihuizen, Hanneke
Tempelman, Henk
Vandeput, David
Knol, Dirk L
Kamper, Steven J
Ostelo, Raymond W
J Orthop Sports Phys Ther. 2016 Jan 26:1-29. N2 -

Study Design Prospective cohort, test-retest design. Background DP/CEN and DP/non-CEN are common pain pattern responses assessed by Mechanical Diagnosis & 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 if clinical signs of impaired spinal control improve immediately after eliciting a directional preference with centralization response (DP/CEN), or a directional preference without centralization response (DP/non-CEN), in patients with nonspecific low back pain (LBP). Methods Participants underwent a standardized MDT assessment and were classified in a pain pattern subgroup; DP/CEN, DP/non-CEN, or no-DP. Clinical signs of impaired spinal control were assessed pre- 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- and post-MDT assessment were calculated for the three pain pattern subgroups and compared with Chi-square tests. We hypothesized that a larger proportion of patients in the DP/CEN subgroup would improve on spinal control than patients categorized as DP/non-CEN or no-DP. Results Of 114 patients recruited, 51 patients (44.7%) were categorized as DP/CEN, 23 (20.2%) as DP/non-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/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/CEN subgroup (50%) improved on the ASLR test than in the no-DP subgroup (8%, P < .01) or the DP/non-CEN subgroup (7%, P = .01). Changes in Trendelenberg and prone instability tests did not reach statistical significance. Conclusions Immediately following MDT assessment, a larger proportion of patients with a DP/CEN pain pattern showed improvement in clinical signs of spinal control compared to patients with a DP/non-CEN or no-DP pain pattern. Level of Evidence 2b. J Orthop Sports Phys Ther, Epub 26 Jan 2016. doi:10.2519/jospt.2016.6158.

PY - 2016 SN - 1938-1344 (Electronic)
0190-6011 (Linking) SP - 1 EP - 29 T2 - Journal of Orthopaedic and Sports Physical Therapy TI - The Influence of Centralization and Directional Preference on Spinal Control in Patients With Nonspecific Low Back Pain Y2 - FY16 ER -