Clinical prediction rules (CPR) are meant to identify patients who would benefit from certain rehabilitation protocols. This study looked at the current CPR for identifying patients most likely to improve with lumbar stabilization exercise (LSE). The current CPR suggests four variables possess the greatest predictive power for treatment success:
1) Age <40
2) Straight leg raise (SLR) > 91 degrees
3) The presence of aberrant lumbar movement
4) Positive prone instability test
When at least 3 of these 4 variables are present, the probability of a successful treatment is 67%.
What was done
One-hundred-five patients with LBP underwent an examination to determine their CPR status. Patients were then stratified to the LSE or an intervention consisting of manual therapy and range of motion/flexibility exercises (MT). Both interventions were 11 treatment sessions delivered over 8 weeks. Disability was measured via the Oswestry Disability Index completed by the patient. The LSE treatment consisted of abdominal drawing in a maneuver in varying position and varying limb movements. The MT included manipulations of the lumbar spine and hip stretches.
Patients receiving LSE, those fitting the CPR status had less disability by the end compared to those not fitting into the CPR. Also, those with the CPR status and receiving LSE had significantly less disability at the end of treatment compared to the MT group. If the patient had aberrant movement and a positive prone instability test (PIT), the CPR would have shown greater effect.
The previously suggested CPR was not validated. The use of only aberrant lumbar movement and a prone instability test may benefit most from the LSE program.
If someone with LBP has aberrant lumbar movement and a positive prone instability test, an LSE program appears most beneficial. However, one must question ADIM for maximal spinal stability.
- Rabin A, Shashua A, Pizem K, Dickstein R, Dar G. A Clinical Prediction Rule to Identify Patients With Low Back Pain Who Are Likely to Experience Short-Term Success Following Lumbar Stabilization Exercises: A Randomized Controlled Validation Study.J Orthop Sports Phys Ther. 2013 Nov 21. [Epub ahead of print]