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European Spine Journal

, Volume 18, Issue 7, pp 1041–1049 | Cite as

The value of physical performance tests for predicting therapy outcome in patients with subacute low back pain: a prospective cohort study

  • Babak Moradi
  • Julia Benedetti
  • Anita Zahlten-Hinguranage
  • Marcus Schiltenwolf
  • Eva Neubauer
Original Article

Abstract

Considering the enormous costs of intensive multidisciplinary treatment, predictive tests for therapy outcome are needed to evaluate patients’ performance potential and increase cost effectiveness. Somatic parameters are commonly used to evaluate health status and serve as an additional means of forecasting the prognosis, yet little is known of their validity. In this study, we investigated the prognostic value of somatic parameters regarding the outcome of multidisciplinary treatment in patients with subacute low back pain. The study was designed as a prospective cohort study of 162 patients. Somatic parameters were assessed with three physical performance tests (Villiger test, Oesch test, Biering–Sørensen test) before treatment (T0), after 3 weeks’ inpatient therapy (T1) and at 6-month follow-up (T2). Psychometric characteristics of subjective pain perception (VAS), a pain disability index (PDI) and a physical capability index (FFbH-R) were recorded. Correlation coefficients between the physical performance test scores and psychometric characteristics were calculated. To predict therapy outcome, discriminant analyses were performed. A control group (n = 30) was evaluated at similar time points without receiving any therapy. Our results demonstrate good discrimination between patients and controls by means of the investigated performance tests and exhibit a significant negative correlation with the psychometric data. Lower outcome values at study entry correlated with higher pain intensity and disability after multidisciplinary treatment. However, the statistical magnitude of correlation was relatively low and further discriminant analysis did not reveal any predictive value. Consequently the physical performance tests do not have a prognostic value regarding therapy outcome.

Keywords

Physical performance test Prognostic value Villiger test Oesch test Biering–Sørensen test 

Notes

Conflict of interest statement

No funds were received in support of this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supplementary material

586_2009_965_Fig4_ESM.jpg (292 kb)

Oesch test. The patient lies in a supine position while holding two 3-kg weights with straight arms against gravity for 3 min. Early cessation is counted as a positive test

586_2009_965_Fig5_ESM.jpg (27 kb)

Villiger test. The patient is asked to step up and down a 30-cm-high step for 3 min, which requires four steps per cycle. We measured the number of steps and the duration. Early cessation is counted as a positive test

References

  1. 1.
    Andersson GB (1997) The epidemilogy of spinal disorders, 2nd edn. Lippincott- Raven, PhiladelphiaGoogle Scholar
  2. 2.
    Badley EM, Rasooly I, Webster GK (1994) Relative importance of musculoskeletal disorders as a cause of chronic health problems, disability, and health care utilization: findings from the 1990 Ontario health survey. J Rheumatol 21:505–514PubMedGoogle Scholar
  3. 3.
    Bendix AF, Bendix T, Haestrup C (1998) Can it be predicted which patients with chronic low back pain should be offered tertiary rehabilitation in a functional restoration program? A search for demographic, socioeconomic, and physical predictors. Spine 23:1775–1783PubMedCrossRefGoogle Scholar
  4. 4.
    Biering-Sorensen F (1984) Physical measurements as risk indicators for low-back trouble over a one-year period. Spine 9:106–119PubMedCrossRefGoogle Scholar
  5. 5.
    Bombardier C (2000) Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine 25:3100–3103PubMedCrossRefGoogle Scholar
  6. 6.
    Chibnall JT, Tait RC (1994) The pain disability index: factor structure and normative data. Arch Phys Med Rehabil 75:1082–1086PubMedCrossRefGoogle Scholar
  7. 7.
    Crook J, Milner R, Schultz IZ et al (2002) Determinants of occupational disability following a low back injury: a critical review of the literature. J Occup Rehabil 12:277–295PubMedCrossRefGoogle Scholar
  8. 8.
    Deyo RA, Battie M, Beurskens AJ et al (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine 23:2003–2013PubMedCrossRefGoogle Scholar
  9. 9.
    Farrar JT, Portenoy RK, Berlin JA et al (2000) Defining the clinically important difference in pain outcome measures. Pain 88:287–294PubMedCrossRefGoogle Scholar
  10. 10.
    Feuerstein M, Beattie P (1995) Biobehavioral factors affecting pain and disability in low back pain: mechanisms and assessment. Phys Ther 75:267–280PubMedGoogle Scholar
  11. 11.
    Gatchel RJ, Gardea MA (1999) Psychosocial issues: their importance in predicting disability, response to treatment, and search for compensation. Neurol Clin 17:149–166PubMedCrossRefGoogle Scholar
  12. 12.
    Gatchel RJ (2001) A biopsychosocial overview of pretreatment screening of patients with pain. Clin J Pain 17:192–199PubMedCrossRefGoogle Scholar
  13. 13.
    Gross DP, Battie MC, Cassidy JD (2004) The prognostic value of functional capacity evaluation in patients with chronic low back pain: part 1 timely return to work. Spine 29:914–919PubMedCrossRefGoogle Scholar
  14. 14.
    Guzman J, Esmail R, Karjalainen K et al (2001) Multidisciplinary rehabilitation for chronic low back pain: systematic review. BMJ 322:1511–1516PubMedCrossRefGoogle Scholar
  15. 15.
    Guzman J, Esmail R, Karjalainen K et al (2001) Multidisciplinary rehabilitation for chronic low back pain: systematic review. Br Med J 322:1511–1516CrossRefGoogle Scholar
  16. 16.
    Guzman J, Esmail R, Karjalainen K et al (2001) Multidisciplinary rehabilitation for chronic low back pain: systematic review. BMJ 322:1511–1516PubMedCrossRefGoogle Scholar
  17. 17.
    Hamberg-van Reenen HH, Ariens GAM, Blatter BM (2007) A systematic review of the relation between physical capacity and future low back and neck/shoulder pain. Pain 130:93–107PubMedCrossRefGoogle Scholar
  18. 18.
    Hicks GS, Duddleston DN, Russell LD et al (2002) Low back pain. Am J Med Sci 324:207–211PubMedCrossRefGoogle Scholar
  19. 19.
    van der Hulst M, Vollenbroek-Hutten MMR, IJzerman MJ (2005) A systematic review of sociodemographic, physical, and psychological predictors of multidisciplinary rehabilitation—or, back school treatment outcome in patients with chronic low back pain. Spine 30:813–825PubMedCrossRefGoogle Scholar
  20. 20.
    Hultman G, Nordin M, Saraste H et al (1993) Body composition, endurance, strength, cross-sectional area, and density of mm erector spinae in men with and without low back pain. J Spinal Disord 6:114–123PubMedCrossRefGoogle Scholar
  21. 21.
    Hurri H, Mellin G, Korhonen O et al (1991) Aerobic capacity among chronic low-back-pain patients. J Spinal Disord 4:34–38PubMedGoogle Scholar
  22. 22.
    Hurri H (1989) The Swedish back school on chronic low back pain II: Part II. Factors predicting the outcome. Scand J Rehabil Med 21:41–44PubMedGoogle Scholar
  23. 23.
    Hutten MM, Hermens HJ, Zilvold G (2001) Differences in treatment outcome between subgroups of patients with chronic low back pain using lumbar dynamometry and psychological aspects. Clin Rehabil 15:479–488PubMedCrossRefGoogle Scholar
  24. 24.
    Indahl A (2004) Low back pain: diagnosis, treatment, and prognosis. Scand J Rheumatol 33:199–209PubMedCrossRefGoogle Scholar
  25. 25.
    Infante-Rivard C, Lortie M (1997) Relapse and short sickness absence for back pain in the six months after return to work. Occup Environ Med 54:328–334PubMedCrossRefGoogle Scholar
  26. 26.
    Jensen MP, Turner JA, Romano JM (1994) Correlates of improvement in multidisciplinary treatment of chronic pain. J Consult Clin Psychol 62:172–179PubMedCrossRefGoogle Scholar
  27. 27.
    Käser L, Mannion AF, Rhyner A et al (2001) Active therapy for chronic low back pain. Part 2: effects on paraspinal muscle cross-sectional area, fiber type size, and distribution. Spine 26:909–919PubMedCrossRefGoogle Scholar
  28. 28.
    Keller A, Hellesnes J, Brox JI (2001) Reliability of the isokinetic trunk extensor test, Biering-Sørensen test, and Åstrand bicycle test. Spine 26:771–777PubMedCrossRefGoogle Scholar
  29. 29.
    Kelsey JL, White AAIII (1980) Epidemiology and impact of low-back pain. Spine 5:133–142PubMedCrossRefGoogle Scholar
  30. 30.
    Klaber Moffett JA, Carr J, Howarth E (2004) High fear-avoiders of physical activity benefit from an exercise program for patients with back pain. Spine 29:1167–1173PubMedCrossRefGoogle Scholar
  31. 31.
    Kohlmann T, Raspe HH (1996) Der Funktionsfragebogen Hannover zur alltagsnahen Diagnostik der Funktionsbeeinträchtigung durch Rückenschmerzen (FFbH-R). Rehabilitation 35:1–8Google Scholar
  32. 32.
    Kool JP, Oesch PR, de Bie RA (2002) Predictive tests for non-return to work in patients with chronic low back pain. Eur Spine J 11:258–266PubMedCrossRefGoogle Scholar
  33. 33.
    Kroll W (1963) Reliability variations of strength in test–retest situations. Res Q 34:50–55Google Scholar
  34. 34.
    Latimer J, Maher CG, Refshauge K (1999) The reliability and validity of the Biering–Sorensen test in asymptomatic subjects and subjects reporting current or previous nonspecific low back pain. Spine 24:2085–2090PubMedCrossRefGoogle Scholar
  35. 35.
    Long AL (1995) The centralization phenomenon. Its usefulness as a predictor or outcome in conservative treatment of chronic low back pain (a pilot study). Spine 20:2513–2520PubMedCrossRefGoogle Scholar
  36. 36.
    Luoto S, Heliovaara M, Hurri H et al (1995) Static back endurance and the risk of low-back pain. Clin Biomech 10:323–324CrossRefGoogle Scholar
  37. 37.
    Luoto S, Taimela S, Alaranta H et al (1998) Psychomotor speed in chronic lowback pain patients and healthy controls: construct validity and clinical significance of the measure. Percept Mot Skills 87:1283–1296PubMedGoogle Scholar
  38. 38.
    Madsen OR (1996) Trunk extensor and flexor strength measured by Cybex 6000 dynamometer. Spine 21:2770–2776PubMedCrossRefGoogle Scholar
  39. 39.
    Mannion AF, Dvorak J, Taimela S et al (2001) Kraftzuwachs nach aktiver Therapie bei Patienten mit chronischen Rückenschmerzen (LBP). Schmerz 15:468–473PubMedCrossRefGoogle Scholar
  40. 40.
    Mayer T, Gatchel R, Betancur J et al (1995) Trunk muscle endurance measurement: Isometric contrasted to isokinetic testing in normal subjects. Spine 20:920–926 discussion 926–7PubMedCrossRefGoogle Scholar
  41. 41.
    McBeth J (2007) Epidemiology of musculoskeletal pain. Best Pract Res Clin Rheumatol 21:403–425PubMedCrossRefGoogle Scholar
  42. 42.
    McCracken LM, Turk DC (2002) Behavioral and cognitive-behavioral treatment for chronic pain—outcomes, predictors of outcome and treatment process. Spine 27:2564–2573PubMedCrossRefGoogle Scholar
  43. 43.
    Nicolaisen T, Jorgensen K (1985) Trunk strength, back muscle endurance and low back trouble. Scand J Rehabil Med 17:121–127PubMedGoogle Scholar
  44. 44.
    Oesch P, Kool JP, Sloksnath U et al (1994) Die Zuverlässigkeit und Empfindlichkeit von 4 isometrischen Muskeltests. Physiotherapie 6:4–12Google Scholar
  45. 45.
    Rainville J, Ahern DK, Phalen L et al (1992) The association of pain with physical activities in chronic low back pain. Spine 17:1060–1064PubMedCrossRefGoogle Scholar
  46. 46.
    Report of the Quebec task Force on Spinal Disorders (1987) Scientific approach to the assessment and management of activityrelated spinal disorders. Spine 12:1–16CrossRefGoogle Scholar
  47. 47.
    Robert JJ, Blide RW, McWorther K et al (1995) The effects of a work hardening program on cardiovascular fitness and muscular strength. Spine 20:1187–1193PubMedCrossRefGoogle Scholar
  48. 48.
    Scalzitti DA (1997) Screening for psychological factors in patients with low back problems: Waddell’s nonorganic signs. Phys Ther 77:306–312PubMedGoogle Scholar
  49. 49.
    Schiltenwolf M, Buchner M, Heindl (2006) Comparison of a biopsychosocial therapy (BT) with a conventional biomedical therapy (MT) of subacute low back pain in the first episode of sick leave—a randomized controlled trial. Eur Spine J 15:1083–1092Google Scholar
  50. 50.
    Seferlis T, Nemeth G, Carlsson AM (2000) Prediction of functional disability, recurrences, and chronicity after 1 year in 180 patients who required sick leave for acute low-back pain. J Spinal Disord 13:470–477PubMedCrossRefGoogle Scholar
  51. 51.
    Tait RC, Chibnall JT, Krause S (1990) The pain disability index: psychometric properties. Pain 40:171–182PubMedCrossRefGoogle Scholar
  52. 52.
    Truchon M (2001) Determinants of chronic disability related to low back pain: towards an integrative biopsychosocial model. Disabil Rehabil 23:758–767PubMedCrossRefGoogle Scholar
  53. 53.
    Van den Hoogen HJ, Koes BW, Deville W et al (1997) The prognosis of low back pain in general practice. Spine 22:1515–1521PubMedCrossRefGoogle Scholar
  54. 54.
    Van Tulder MW, Koes BW (2002) Chronic low back pain and sciatica. Clin Evid 7:1032–1048PubMedGoogle Scholar
  55. 55.
    Van Tulder MW, Ostelo RW, Vlaeyen JW et al (2004) Behavioural treatment for chronic low back pain (Cochrane Review) 2. In: The Cochrane Library, Issue 3. Wiley, ChichesterGoogle Scholar
  56. 56.
    Villiger B, Egger K, Lerch R et al (1995) The 3-minute step test. In: Villiger B (ed) Endurance. Thieme, StuttgartGoogle Scholar
  57. 57.
    Vlaeyen JW, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85:317–332PubMedCrossRefGoogle Scholar
  58. 58.
    Waddell G (1991) Low back pain disability, a syndrome of western civilisation. Neurosurg Clin N Am 2:719–738PubMedGoogle Scholar
  59. 59.
    Weiser S, Cedraschi C (1992) Psychosocial issues in the prevention of chronic low back pain: a literature review. Baillieres Clin Rheumatol 6:657–684PubMedCrossRefGoogle Scholar
  60. 60.
    White AA III, Panjabi MM (1990) clinical biomechanics of the spine, 2nd edn. Lippincott, PhiladelphiaGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Babak Moradi
    • 1
  • Julia Benedetti
    • 1
  • Anita Zahlten-Hinguranage
    • 2
  • Marcus Schiltenwolf
    • 1
  • Eva Neubauer
    • 1
  1. 1.Orthopaedic ClinicUniversity HeidelbergHeidelbergGermany
  2. 2.Department of Translational OncologyNational Center for Tumor Diseases (NCT)HeidelbergGermany

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