Association Between Directional Preference and Centralization in Patients With Low Back Pain

Werneke, Mark W.; Hart, Dennis L.; Cutrone, Guillermo; Oliver, Dave; McGill, Maj Troy; Weinberg, J; Grigsby, David; Oswald, William; Ward, Jason

doi:10.2519/jospt.2011.3415

Cited by 58 publications

(48 citation statements)

References 58 publications

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“…8,52,54 Data from our research group suggest that the predictive ability of models improves when variables for classifying patients in clinically logical ways are included. 76 Compared to the R 2 value for our current model with the FABQ-PA variable (R 2 = 0.30), the R 2 value reported by Werneke et al 76 when a classification variable was added to the same model (R 2 = 0.50) represents approximately a 66% gain in predictive ability. Hence, support is growing to include clinical classification variables in FS predictive models.…”

Section: Discussionmentioning

confidence: 60%

“…Both FS estimates and FABQ-PA classification are based on item response theory (IRT) methods. 44,61 Literature supports the psychometric and practical strength of the FS scores estimated using the IRT-based lumbar CAT administration, 8,25,30,70,[76][77][78] but additional prospective study is needed to validate whether a single-item screening scale represents the construct of fear-avoidance beliefs of physical activities well. IRT methods are complex, but the advantages are clinically logical and practical.…”

Section: Discussionmentioning

confidence: 98%

“…The lumbar CAT has been developed and simulated, 25 and is in routine clinical use in the United States 76,77 and Israel. 7,8 Briefly, items in the lumbar CAT item bank represent functional activities, like "bending or stooping."…”

Section: Lumbar Cat and Fs Measuresmentioning

confidence: 99%

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Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

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Functional status (FS) outcomes of patients with lumbar spine dysfunctions managed in outpatient rehabilitation clinics are affected by many variables, including patient demographic variables. 35 Before clinicians can interpret associations between treatments and outcomes in a meaningful way, FS outcomes must be statistically risk-adjusted to control the effect of variables that may or may not be related to clinical care. 8,23,33,35,52 Although statistical risk adjustment models can appear complicated, 53,54 results of these models tend to be clinically logical. For example, it is clinically logical that patients who are older or patients whose symptoms are more chronic should report less FS change compared to patients who are younger or have more acute symptoms, and, indeed, results support this inverse relationship (ie, as patients age, or symptoms become chronic, FS T T STUDY DESIGN: Retrospective analysis of a prospective, longitudinal cohort study of 30 858 patients being treated for a lumbar spine dysfunction in outpatient physical therapy. T T OBJECTIVES:To determine effect of adding a single-item screening variable classifying patients with elevated versus not-elevated scores of fearavoidance beliefs of physical activities at intake, on a model predicting risk-adjusted functional status (FS) outcomes. T T BACKGROUND:Outcomes must be risk-adjusted before making meaningful interpretations. Elevated fear-avoidance beliefs scores have been predictive of poor outcomes. But the importance of elevated fear-avoidance scores in a multivariable model predicting FS outcomes needs further study. T T METHODS:Using retrospective analyses, predictive ability (R 2 ) of multivariable linear regression models of discharge FS with and without classification by elevated versus not-elevated fearavoidance scores were compared, while controlling for intake FS, age, symptom acuity, surgical history, gender, number of comorbidities, and payer. Percent variance controlled and beta coefficients (95% confidence intervals) of each variable in both models were compared. A split-half design was used for model cross-validation. Predictive ratios (predicted FS, divided by actual discharge FS) were assessed. T T RESULTS:Adding fear-avoidance beliefs classification to the discharge FS model improved (P<.001) model predictive ability but only slightly (R 2 without, and with, fear-avoidance classification, 0.2997 and 0.3010, respectively). Variables impacted models similarly (95% confidence intervals not different). Fear-avoidance classification added 0.2% data variance control to the existing model. Cross-validation was supported. Predictive ratios were 1.09 and 1.10, without and with fearavoidance, respectively. T T CONCLUSION:Although screening for elevated fear-avoidance beliefs of physical activities significantly improves the FS outcomes predictive model, the amount of additional meaningful interpretation of FS outcomes was minimal. Exploration of other clinically relevant variables designed to improve outcomes prediction is warranted...

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 98%

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Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

Self Cite

View full text Add to dashboard Cite

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“…The eleven variables included for risk adjustment were intake FS, 10,22,24,33,44,46 intake pain intensity, [66][67][68] 44,47 and number of comorbid conditions. 10,21,45 These eleven variables were specifically selected for inclusion in our linear-regression models, because the previously cited studies demonstrated that each variable influenced FS or pain outcomes in predictive models.…”

Section: Risk Adjustment Factorsmentioning

confidence: 99%

Change in Psychosocial Distress Associated With Pain and Functional Status Outcomes in Patients With Lumbar Impairments Referred to Physical Therapy Services

Werneke

Hart²,

George³

et al. 2011

J Orthop Sports Phys Ther

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“…Peripheralizing pain means that distal symptoms are produced and/or distal symptoms are made worse. After classification, patients with a centralizing pain response are treated with MDT, because for 'centralizers' there is some evidence that MDT is more effective than other physical therapy approaches [8][9][10][11]. Patients with a peripheralizing pain response are treated with TESIs.…”

Section: Introductionmentioning

confidence: 99%

Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery

Helvoirt

Apeldoorn

Knol

et al. 2016

BMR

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Abstract. STUDY DESIGN: Prospective cohort study. BACKGROUND: Although lumbar radiculopathy is regarded as a specific diagnosis, the most effective treatment strategy is unclear. Commonly used treatments include transforaminal epidural steroid injections (TESIs) and Mechanical Diagnosis & Therapy (MDT), but no studies have investigated the effectiveness of this combination. MDT differentiates pain centralization (C) from non-centralization (NC), which indicates good vs. poor prognostic validity respectively. OBJECTIVE: The main aims were 1) to determine changes in Mechanical Diagnosis and Therapy (MDT) pain response classifications after transforaminal epidural steroid injections (TESIs) in candidates for lumbar herniated disc surgery and 2) to evaluate differences in short and long term outcomes for patients with different pain response classifications. METHODS: Candidates for lumbar herniated disc surgery were assessed with a MDT protocol and their pain response classified as centralizing or peripheralizing. For this study,only patients were eligible who showed a peripheralizing pain response at intake. All patients then received TESIs and were reassessed and classified using the MDT protocol, into groups according to pain response (resolved, centralizing, peripheralizing with less pain and peripheralising with severe pain). After receiving targeted treatment based on pain response after TESIs, ranging from advice, MDT or surgery, follow-up assessments were completed at discharge and at 12 months. The primary outcomes were disability (Roland-Morris Disability Questionnaire [RMDQ] for Sciatica), pain severity in leg (visual analogue scale [VAS], 0-100) and global perceived effect (GPE). Linear mixed-models were used to determine between-groups differences in outcome. RESULTS: A total of 77 patients with lumbar disc herniation and peripheralizing symptoms were included. Patients received an average of 2 (SD 0.7) TESIs. After TESIs, 17 patients (22%) were classified as peripheralizing with continuing severe pain. H. van Helvoirt et al. / Transforaminal epidural steroid injections influence MDT pain response classificationThese patients underwent surgery and were not further evaluated. Eleven (14%) patients were classified as resolved, 37 (48%) as centralizing with significant less pain, and 12 (16%) as peripheralizing with significant less pain. None of these patients underwent surgery. Resolved and centralizer subgroups had better outcomes in terms of VAS and RMDQ than the non-operated peripheralizers at discharge and at 12 months. The succes rates (GPE) for the resolved, centralizing, and peripheralizing with less pain patients were 100%, 100% and 33% respectively at short term, and 100%, 92% and 50% respectively at long term. CONCLUSION: After TESIs, a peripheralizing pain pattern changed to resolved or centralizing in 62% of the patients. For the non-operated patients, those with a centralising pattern after TESIs reported better pain and disability outcomes than those with peripheralizing pattern at short ...

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Association Between Directional Preference and Centralization in Patients With Low Back Pain

Cited by 58 publications

References 58 publications

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Change in Psychosocial Distress Associated With Pain and Functional Status Outcomes in Patients With Lumbar Impairments Referred to Physical Therapy Services

Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery

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