Conclusions For most clinical tests in LBP there is not consistent evidence for an association with outcome .
Central ization and non-organic signs are exceptions from that .
Background There is a strong tradition of performing a clinical examination of low back pain ( LBP ) patients and this is generally recommended in guidelines .
However , establishing a pathoanatomic diagnosis does not seem possible in most LBP patients and clinical tests may potentially be more relevant as prognostic factors .
The aim of this review of the literature was to systematic ally assess the association between low-tech clinical tests commonly used in adult patients with acute , recurrent or chronic LBP and short- and long-term outcome .
Centralization: Its Prognostic Value in Patients With Referred Symptoms and Sciatica
Study Design . Prospect i ve , comparative cohort study . Objective . To investigate the prognostic significance of central ization in patients with subacute sciatica and referred symptoms . Summary of Background Data . Previous studies have shown that central ization occurs commonly in the nonspecific low back population , and its occurrence is associated with a good prognosis . The phenomenon has never been evaluated in a population with sciatica and referred symptoms . Methods . The sample pool was 104 consecutive patients referred for investigation of possible disc herniation . Of these patients , 60 were recruited into the study and underwent a st and ardized mechanical evaluation using repeated end-range movements , while symptom response was monitored to expose 2 groups : central ization group ( CG ) and non central ization group ( NCG ) . All patients were treated in the same way and were followed for one year . If patients did not have improvement surgery was considered . Outcomes included back and leg pain , disability , Nottingham Health Profile , and surgical outcome . Results . There were 25 patients who were classified in the CG , 35 in the NCG , and other baseline characteristics were similar between groups . At 1 , 2 , and 3 months , the CG had significantly better outcomes than the NCG . At 2 months , the CG had more improvements in leg pain ( P = 0.007 ) , disability ( P = < 0.001 ) , and Nottingham Health Profile ( P = 0.001 ) . After 1 year , disability was less in the CG ( P = 0.029 ) . In the CG , 3 patients underwent surgery , in the NCG , 16 ( P = 0.01 ) . The odds ratio for surgery in the NCG was 6.2 . Conclusion . Patients with sciatica and suspected disc herniation who have a central ization response to a mechanical evaluation will have significantly better outcomes . Patients who do not have central ization will be 6 times more likely to undergo surgery
Conclusions For most clinical tests in LBP there is not consistent evidence for an association with outcome .
Central ization and non-organic signs are exceptions from that .
Background There is a strong tradition of performing a clinical examination of low back pain ( LBP ) patients and this is generally recommended in guidelines .
However , establishing a pathoanatomic diagnosis does not seem possible in most LBP patients and clinical tests may potentially be more relevant as prognostic factors .
The aim of this review of the literature was to systematic ally assess the association between low-tech clinical tests commonly used in adult patients with acute , recurrent or chronic LBP and short- and long-term outcome .