No abstract

Objectives: Patients with low back pain (LBP) commonly have lumbopelvic control deficits. Lumbopelvic assessment during sagittal motion is incorporated into commonly used clinical examination algorithms for Treatment Based Classification. The purpose of this study was to investigate whether combined assessment of lumbopelvic control during sagittal and frontal plane motion discriminates between people with and without LBP better than single plane assessment alone. Methods: Nineteen patients with LBP and 18 healthy control participants volunteered for this study. The active straight leg raise (ASLR) and active hip abduction (AHAbd) tests were used to assess lumbopelvic control during sagittal and frontal plane motion, respectively. The tests were scored as positive or negative using published scoring criteria. Contingency tables were created for each test alone and for the combined tests (both positive/both negative) with presence/absence of LBP as the reference standard to calculate accuracy statistics of sensitivity (sn), specificity (sp), likelihood (zLR and 2LR), and diagnostic odds ratios (OR). Results: Active straight leg raise and AHAbd tests alone had sn of 0.63, 0.74, respectively, sp of 0.61, 0.50, respectively, and OR of 2.7, 2.8, respectively. The combined tests had sn50.89, sp50.60, and OR512.0. Forty percent of patients with LBP had control deficits in both planes of motion. Discussion: The AHAbd and ALSR tests appear to have greater diagnostic discrimination when used in combination than when used independently. A percentage of patients with LBP had control deficits in both planes, while others demonstrated uniplanar deficits only. These findings highlight the importance of multiplanar assessment in patients with LBP.Keywords: Low back pain, Lumbopelvic assessment, Active straight leg raise, Active hip abduction Level of Evidence: 2b (Diagnosis -exploratory cohort study with independent reference standard). ObjectivesLow back disorders are a significant health care issue in North America with an age-adjusted rate of 27.8% of all people over the age of 18 years reporting low back pain (LBP) each year, 1 and 80% of all individuals experiencing an episode of LBP during their lifetimes. 2 The economic and social impact of LBP is large, accounting for 1 in 25 health care resource visits resulting in an annual cost of $193.9 billion. 1 Despite the enormous resources that are dedicated to management of LBP, successful outcomes remain relatively low, having variable recurrence rates (5-60%) with an estimated 20% progressing into chronicity. 3The majority of individuals seeking treatment for LBP have no detectable structural cause with current imaging techniques and are therefore given the diagnosis of non-specific LBP (ns-LBP).4 Dysfunctional movement strategies, including kinematic and muscle activation differences, have been identified in people with ns-LBP when compared to healthy controls. [5][6][7][8] Asymptomatic people who reported a LBP response to a functional standing task also demonstrated diffe...