Original research
Association Between Clinical Tests Related to Motor Control Dysfunction and Changes in Pain and Disability After Lumbar Stabilization Exercises in Individuals With Chronic Low Back Pain

https://doi.org/10.1016/j.apmr.2019.01.019Get rights and content

Abstract

Objective

To investigate whether clinical tests used to detect motor control dysfunction can predict improvements in pain and disability in patients with chronic nonspecific low back pain (LBP) who have undergone an 8-week lumbar stabilization exercise program.

Setting

Outpatient physical therapy university clinic.

Participants

Seventy people with chronic nonspecific LBP were recruited, and 64 completed the exercise program (N=64).

Interventions

The lumbar stabilization program was provided twice a week for 8 weeks.

Main Outcome Measures

Pain intensity (11-point numerical rating scale) and disability (Roland Morris Disability Questionnaire) and clinical tests, such as the Deep Muscle Contraction (DMC) scale, Clinical Test of Thoracolumbar Dissociation (CTTD), and Passive Lumbar Extension (PLE) test. Univariate and multivariate linear regression models were used in the prediction analysis.

Results

Mean changes in pain intensity and disability following the 8-week stabilization program were −3.8 (95% confidence interval [CI], −3.2 to −4.4) and −7.4 (95% CI, −6.3 to −8.5), respectively. Clinical test scores taken at baseline did not predict changes in pain and disability at 8-week follow-up.

Conclusion

Our findings revealed that the DMC scale, CTTD, PLE test, clinical tests used to assess motor control dysfunction, do not predict improvements in pain and disability in patients with chronic nonspecific LBP following an 8-week lumbar stabilization exercise program.

Section snippets

Methods

The protocol of this exploratory prospective cohort study was registered in clinicaltrials.gov (NCT02398760).

Results

A total of 96 participants were assessed for eligibility between July 2014 and August 2015, and 70 participants were considered eligible. Six participants did not complete the program. Reasons for noncompletion were (1) lack of time (n=5) and (2) refusal to participate with no reasons provided (n=1). Therefore, 64 participants (91%) completed the lumbar stabilization exercise program. Table 1 describes the sample characteristics.

Baseline, post treatment, change scores, and effect sizes for

Discussion

Our findings show that scores from the DMC scale, CTTD, and PLE test measured at baseline do not predict improvements in pain intensity and disability following an 8-week lumbar stabilization exercise program. Our results are in accordance with recent evidence questioning the utility of this subgroup because of limited effectiveness, credibility, and validation.33, 34, 35

The CTTD failed to predict changes in clinical outcomes in patients with chronic LBP undergoing an 8-week lumbar

Conclusions

Our findings revealed that the DMC scale, CTTD, and PLE test clinical tests assessing motor control dysfunctions do not predict improvements in pain intensity and disability in patients with chronic nonspecific LBP undergoing an 8-week lumbar stabilization exercise program. The results from this study do not support claims that it is possible to identify a subgroup of patients with chronic LBP who would respond to a course of lumbar stabilization exercise program with clinical tests.

Supplier

  • a.

    SPSS version 20.0; IBM.

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  • Disclosures: S.M.S. receives salary support from The National Health and Medical Research Council of Australia (1105040). The other authors have nothing to disclose.

    Clinical Trial Registration No.: NCT02398760.

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