Editor's note: Due to space constraints, we are unable to reprint all of the abstracts from the May 2007 issue of JMPT. To review the complete table of contents for the May issue, visit www.mosby.com/jmpt.
Low back pain: clinimetric properties of the Trendelenburg test, active straight-leg-raise test, and breathing pattern during active straight-leg raising.
Nathalie A.
Objective: Classification of patients with low back pain (LBP) into subgroups is important as considerable variability exists in the LBP population. Clinical applicable, reliable, and valid tests to differentiate patients with LBP are therefore necessary. The purpose of this study is to examine the reliability, internal consistency, and clinical importance of three clinical tests that analyze motor control mechanisms of the lumbopelvic region in patients with nonspecific LBP.
Methods: Thirty-six patients with chronic nonspecific LBP volunteered for the study (cross-sectional design). The patients were examined by two assessors who were blinded to the results of each other. The following tests were performed: the Trendelenburg test, the active straight-leg-raise (ASLR) test, and the ASLR with visual inspection of the breathing pattern.
Results: The test-retest reliability coefficients (K) were greater than 0.75 for the Trendelenburg score and greater than 0.70 for the ASLR. The interobserver reliability coefficients were greater than 0.39 for the assessment of the breathing pattern during the ASLR. The Cronbach α coefficient for internal consistency of the Trendelenburg and ASLR tests was greater than .73. No significant associations were found between the outcome of the tests and self-reported pain severity or disability.
Conclusion: These data provide evidence favoring the test-retest reliability of the Trendelenburg and ASLR tests in patients with LBP. The internal consistency of the outcome of these tests was high for both assessors, suggesting that these tests assess the same dimension. The interobserver reliability of the assessment of the breathing pattern was fair to moderate. Further research regarding the interobserver reliability, clinical importance, validity, and responsiveness of the Trendelenburg test, ASLR test, and breathing pattern during these tests is required.
Interrater reliability and diagnostic accuracy of pelvic girdle pain classification.
Chad Cook, PT, PhD, MBA, Lisa Massa, MPT, Ingrid Harm-Ernandes, PT, Rachel Segneri, SPT, Jennifer Adcock, SPT, Colleen Kennedy, DPT, Carol Figuers, PT, EdD
Objective: The purpose of this study was to measure the reliability of a classification system for pelvic girdle pain (PGP) and diagnostic accuracy of selected examination and clinical special findings for diagnosis of PGP.
Methods: The design involved a prospective epidemiological study of pregnancy-related PGP. Consecutive subjects were recruited and classified using criteria defined by previous studies. Two clinicians examined the subjects and classified each patient into one of five classification groups. Clinical examination and clinical special tests were performed on the patients with PGP. Statistical analysis involved interobserver agreement using a K statistic and sensitivity and specificity values for the examination and clinical special testing.
Results: Twenty-one subjects were included in the analyses. Aggregated percentage of agreement for the classification system was 84.6%. The Cohen K was 0.78 (CI, 0.64-0.92; P < .0001), which indicated substantial agreement during selection of the classification system. Most clinical examination and clinical special-test findings demonstrated low sensitivity and high specificity, whereas clusters of findings including the lunge, manual muscle testing of the hip (lower extremities), and passive range of motion of the hip demonstrated the strongest diagnostic value.
Conclusion: Selected tests and measures are moderately discriminatory in diagnosing PGP. A classification system for diagnosing PGP demonstrates strong agreement and may be useful for clinicians.
Comparison of the Neck Disability Index and the Neck Bournemouth Questionnaire in a sample of patients with chronic uncomplicated neck pain.
Ralph E. Gay, MD, DC, Timothy J. Madison, PT, MS, Kathryn R. Cieslak, PT, OCS
Objective: This study compares the sensitivity to change of the Neck Disability Index (NDI) and the Neck Bournemouth Questionnaire (NBQ) in patients with chronic uncomplicated neck pain.
Methods: This prospective longitudinal study was completed in an outpatient physical therapy clinic. Subjects, with uncomplicated neck pain (no concurrent shoulder pain or nerve root symptoms) for more than a 3-month duration, participated in a four-week course of therapy that included moist heat, neck exercises, and either mobilization or massage. Outcome measures included standardized response means (sensitivity to change), Cronbach α (internal consistency), and two-way Spearman correlations between the two questionnaires and between a pain Visual Analog Scale and each questionnaire (convergent validity).
Results: Mean (SD) score change of the NDI was 6.22 (5.12), and of the NBQ, 14.00 (11.99). Standardized response means were 1.21 and 1.17, respectively. Both questionnaires were more sensitive to change than the pain Visual Analog Scale (0.68). There was moderate correlation between the change scores of all three outcome tools (Spearman 0.46-0.57). The NBQ had higher internal consistency than the NDI.
Conclusion: The NDI and the NBQ performed comparably in this group of patients with chronic uncomplicated neck pain. Both are sensitive to change and would be efficient outcome tools in studies of chronic neck pain. Both had acceptable internal consistency and are appropriate for use as single-outcome scales.
Introducing the external link model for studying spine fixation and misalignment: part 2, biomechanical features.
Charles N.R. Henderson, DC, PhD, Gregory D. Cramer, DC, PhD, Qiang Zhang, MD, DC, James W. DeVocht, DC, PhD, Jaeson T. Fournier, DC, MPH
Objectives: The purpose of this study was to characterize intervertebral stiffness and alignment changes in the external link model and evaluate it as an experimental mimic for studying the chiropractic subluxation.
Methods: A controlled test-retest design was used to evaluate rats with spine segments linked in three alignment configurations and controls that were never linked. Dorsal-to-ventral spine stiffness was measured with a load platform, and flexion/extension misalignment was assessed on lateral radiographs obtained with a spine extension jig. Descriptive statistics were computed for study groups, and multiple linear regression models were used to examine all potential explanatory variables for the response variables "stiffness" and "joint position."
Results: Rats tested with links in place had significantly higher dorsal-to-ventral stiffness in the neutral configuration than rats in the flexed configuration. This difference remained after the links were removed. Stiffness after link removal was greater for longer linked periods. Surprisingly, stiffness after link removal was also greater with longer unlinked periods. Longer linked periods also produced greater misalignments during forced spine extension testing. Although link configuration was not a statistically significant predictor of misalignments, longer times after link removal did produce greater misalignments.
Conclusion: This study suggests that the external link model can be a valuable tool for studying the effects of spine fixation and misalignment, two cardinal features of what has been historically described as the chiropractic subluxation. Significant residual stiffness and misalignment remained after the links were removed. The progressive course of this lesion is consistent with subluxation theory and clinical chiropractic experience.
Process development for ethical recruitment of patients into simultaneous clinical studies in a chiropractic research clinic.
Robert M. Rowell, DC, Dana J. Lawrence, DC, Edward F. Owens, JR, MS, DC
Objective: To develop a process at one institution that creates an ethical means to bring other research projects to the attention of an individual who was excluded from the project for which they originally expressed interest, and to discuss the ethical issues surrounding patient recruitment and enrollment.
Methods: General consensus process via meetings of investigators involved in the ongoing trials at one institution.
Results: A process and flow sheet for offering new study information to individuals who did not meet the criteria for participation was developed. Once rejected, an individual can be asked if they wish to learn about other studies, are sent home with information, and are instructed to call back if they wish to volunteer. Consent can be used to take baseline information from the first study and apply it to the second.
Conclusion: This process was developed and implemented for use in this research.
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