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Association Of Risk Stratified Low Back Pain Subgroups With Functional Range Of Motion: A Prospective Cohort Study

1830 words - 8 pages


Low back pain is very common, costly, and burdensome, ranking 1st in disease burden worldwide, out of 289 causes of disability.16 Because of this, there is an urgent global call for standardizing research in collecting pertinent outcomes such as pain, function, quality of life, and psychosocial data.3 There is growing evidence that risk-stratifying7 patients can be simplified. More importantly, risk-stratified care, compared with standard care, resulted in improved general health (0·039 added QALYs) and cost savings of £34 (US $57.67) in the United Kingdom. QALY stands for quality-adjusted life-year that is a measure of disease burden, including both the quality and the quantity ...view middle of the document...

In the clinical environment, most outpatient centers cannot afford fancy instruments2,10 (fMRI, EMG, Ultrasound imaging, etc.) to document movement outcome following motor control training. Physical therapists measure lumbar spine and hip range of motion (ROM) outcome but they do not relate these to illness perception, and self-efficacy in risk-stratified patients.7,8

Low back pain subgroups identified as flexion-rotation, and extension-rotation have opposite amounts of hip joint plus lumbar spine ROM.8 The clinical examination to differentiate these two subgroups is complex and time consuming.8 Physical therapy movement intervention approaches for these two subgroups are completely opposite. Hence, there is a need to identify flexion-rotation, extension-rotation subgroups (based on motion capture of their hip joint and lumbar spine ROM differences) and associate these differing ROM to pain, disability, quality of life, as well as psychosocial variables (of illness perception and self-efficacy) in medium risk-stratified patients suffering from low back pain. This specific information (predictive factors) may help therapists determine these subgroups more efficiently and provide a more targeted movement intervention approach that could further reduce cost and decrease burden to global health brought on by back pain.


Therefore, the study aim is to determine if there is any association between:
1. Low back pain subgroups such as flexion-rotation, and extension-rotation, with controls (based on differing hip joint plus lumbar spine ROM as measured by motion capture system)


2. pain (NPRS), disability (modified Oswestry Disability Index), psychosocial factors (illness perception, self-efficacy)


Study Design
Prospective cohort


The sampling method employed is via emails sent to physical therapy clinics in the community surrounding Sacred Heart University as convenience sample in CT.
Sample features will be similar to published studies4,8 so that age and gender are matched to avoid sampling error and selection bias (those older than 40 may likely have joint related hip motion limitations). To improve response rate, phone calls will be made to follow-up on email and personal invitation. Prospective subjects will be screened over the phone for inclusion and exclusion criteria.

To be included in the study, subjects with low back pain should meet these criteria:
AGE1,4,8,13,15: age 21-39
Sub-acute non-radiating low back pain between 4 weeks and less than 3 months.
Low back pain with medium risk-stratified based on STarT7 Back Screening Tool7,11,13 (Appendix 1)
The STarT Back Screening Tool7,11,13 (SBST) is a brief reliable and valid tool intended to screen patients with low back pain for prognostic indicators that are pertinent to early decision making. When someone is stratified as medium-risk; it means that the patient will need one-on-one conservative therapy to overcome the physical...


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