Validity and Predictive Value of Manual Clinical Test to Identify Symptomatic Segments in Lumbar Chronic Patients

Study Overview
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Brief Summary
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This study evaluates the predictor value of manual test in lumbar chronic patients blocks. Bibliography has show limited evidence of clinical predictors in lumbar blocks. Prior to lumbar facet block or medial branch denervation patient will be evaluated with manual provocative segmental movements, lumbar sagittal range of motion, manual segmental movement and slump neural test . Immediate, one and six months effect will be registered.

Detailed Description
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Clinical tests have sown limit evidence to predict efficacy of lumbar facet blocks. Segmental mobility tests have been included into the protocol to evaluate the efficacy of the lumbar blocks. Chronic low back pain patients will be tested to evaluate the predictor value of manual clinical tests. Patients from the Lozano Blesa Hospital pain clinic will be evaluate before, one month and six months after the lumbar facet block.

Official Title
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Validity and Predictive Value of Manual Clinical Test to Identify Symptomatic Segments in Lumbar Chronic Patients

Conditions
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Low Back Pain

Intervention / Treatment
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* Procedure: lumbar facet block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: more than 3 months of low back pain. lumbar with or without leg pain. patient treated with a lumbar facet block or medial nerve denervation. capable to be physically explored. capable to fill a questionaire. Exclusion Criteria: no mechanical pain. severe medical condition. severe lumbar trauma. severe lumbar instability. severe lumbar deformity psychiatric disorder.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Block group<br>Lumbar facet block. Levobupivacaine 0,25% and corticosteroids | Procedure: lumbar facet block<br>* injection of Levobupivacaine 0,25% and corticosteroids<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain intensity Visual analogue scale |  | baseline before the block | 
| Change of the Pain intensity one hour after the block |  | one hour after the block | 
| Change of the pain intensity one month after the block |  | one month after the block | 
| Change of the pain intensity six months after the block |  | six months after the block | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| range of motion ROM | Measure of the pain free lumbar flexion and extension range of motion. Measured with single inclinometer in grades | baseline before the block | 
| Change of the range of motion ROM | Measure of the pain free lumbar flexion and extension range of motion. Measured with single inclinometer in grades | one month after the block | 
| Change of the range of motion ROM | Measure of the pain free lumbar flexion and extension range of motion. Measured with single inclinometer in grades | six months after the block | 
| lumbar segmental provocation manual test |  | baseline before the block | 
| Change of the lumbar segmental provocation manual test |  | one month after the block | 
| Change of the lumbar segmental provocation manual test |  | six months after the block | 
| lumbar manual segmental joint play test |  | baseline before the block | 
| Change of the lumbar manual segmental joint play test |  | one month after the block | 
| Change of the lumbar manual segmental joint play test |  | six months after the block | 
| Algometer: Pressure Pain threshold | Measure of the pressure pain threshold of the hand and the interspinous ligament from T12 to L5 | baseline before the block | 
| Change of the Algometer: Pressure Pain threshold | Measure of the pressure pain threshold of the hand and the interspinous ligament from T12 to L5 | one month after the block | 
| Change of the Algometer: Pressure Pain threshold | Measure of the pressure pain threshold of the hand and the interspinous ligament from T12 to L5 | six months after the block | 
| oswestry disability index |  | baseline before the block | 
| Change of the oswestry disability index |  | one month after the block | 
| Change of the oswestry disability index |  | six months after the block | 
| hospital anxiety and depression scale |  | baseline before the block | 
| Change of the hospital anxiety and depression scale |  | one month after the block | 
| Change of the hospital anxiety and depression scale |  | six months after the block | 
| 11 point global rating of change scale |  | one month after the block | 
| Change of the 11 point global rating of change scale |  | 6 months after the block | 
| Douleur Neuropathique 4 questionnaire |  | baseline before the block | 
| Change of the Douleur Neuropathique 4 questionnaire |  | one month after the block | 
| Change of the Douleur Neuropathique 4 questionnaire |  | six months after the block | 
| slump neural test |  | baseline before the block | 
| Change of the slump neural test |  | one month after the block | 
| Change of the slump neural test |  | six months after the block | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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low back pain, physical examination, local anesthesia