Physical Therapy (95)
Authors: Cox Martha E. , Asselin Steeve , Gracovetsky Serge A. 
Published: September 2010

Relationship between functional evaluation measures and self‐assessment in nonacute low back pain. (Concordia University, Montréal, Québec, Canada) Spine 2000;25:1817–1826.

In this study, two hypotheses were examined: range of motion and velocity are controllable and inherently correlated with self‐assessment; complex spinal coordination patterns such as range of lordosis cannot be controlled and are independent of self‐assessment. Self‐assessment questionnaires were administered, and indexes of spinal motion and coordination were measured through skin marker kinematics. The correlation between self‐assessments and biomechanical measures was determined. Self‐assessments of function were significantly correlated with parameters prone to regulation: range of motion, velocity, and load lifted. In contrast, little correlation was found with measures of complex spinal coordination less susceptible to conscious or affective regulation, namely, range of lordosis, and estimated segmental mobility. This effect was magnified with increased load. Self‐assessment scores were significantly poorer among insurance referrals, regardless of functional status. Conclude that simple parameters of the functional examination, such as range of motion and velocity, are strongly correlated with cognitive state, and thus the information they supply is less than ideal. Complex spinal coordination is a better indicator of the degree of spinal dysfunction and enhances the process of differentiating between pain, disability, and functional impairment.

Comment by Phillip S. Sizer Jr., MEd, PT.

Numerous approaches to the evaluation of lumbar spine disorders have been proposed. Self‐reported disability scales are frequently implemented, but outcomes can be influenced by patient psychological factors. ROM tests have been frequently used for disability rating, but difficulty is encountered in detecting submaximal patient effort. These investigators evaluated the relationships between the Quebec Back Pain Disability Questionnaire and other self‐assessment measures, simple functional measures, and coordination patterns using the Spinoscope. From these measures the investigators attempted to elucidate a more accurate objective measure of biomechanical impairment independent from affective or self‐assessment influences. The outcomes illustrated that, while simple ROM and velocity measures were strongly correlated with subjective index scores, complex spinal coordination measures were not correlated with the same self‐assessment outcomes. Additionally, the authors suggested that simple ROM does not ensure biomechanical normalcy in movement. Furthermore, they suggested that complex coordination measures that include Range of Lordosis (ROL) and Estimate of Inter‐segmental Mobility (EISM) may serve as a better compliment to the clinical examination findings associated with lumbar conditions. Finally, they suggested that loading the spine during coordination testing further distances the outcomes from the subjective influence of pain and other factors. These measures may be superior to traditional measures for accurate diagnosis and return‐to‐work decisions with patients suffering from seemingly vague conditions, such as nonspecific low back pain.