Clinical Perspective: How Do Clinical Test Results Differentiate Chronic and Subacute Low Back Pain Patients from "Non-Patients"?

Abstract

Our limited understanding of underlying conditions for back pain is reflected in the common use of pain-duration-based groupings. The aim of this paper was to investigate typical clinical tests used in examining low back pain (LBP) patients in order to discover how tests distinguish between chronic low back pain patients (CLBP) and subacute low back pain patients (SLBP) and if they distinguish these groups from those with no "patient status." CLBP patients in this study were from a university hospital and SLBP patients were from five occupational health care centers. Control subjects were recruited from a university. Determination of the best predictors between CLBP and SLBP patients and between CLBP and SLBP patients and non-patients was made by a forward stepwise logistic model. A total of 157 subjects were included in the study. Of all the clinical tests, several tests in each category had high odds ratio, differentiating CLBP patients from controls. Only a few tests differentiated between CLBP and SLBP patients. The only clinical differences between SLBP patients and controls were in the mobility test and in one test of muscle tightness. The best predictor for CLBP was the lumbar spine flexion test. SLBP patients seemed to differ from the control group in lumbar flexion, in a specific anterior-posterior mobility test, and in tightness of hip flexor muscles. CLBP patients differed from SLBP patients in functional tests, in the presence of sensation in the feet, and in different pain provocation tests. Whether these tests are sufficiently sensitive to classify a more specific diagnostic or clinical subgroup remains untested, and further studies with clinical tests to differentiate among pathological conditions are necessary.

Knowledge translation from continuing education to physiotherapy practice in classifying patients with low back pain

“…We previously demonstrated the sensitivity and specificity of the clinical tests used to distinguish clinically relevant subgroups in the early phase of LBP management. 17,18 Based on these studies, the intraand inter-reliability of the clinical tests used for this study and the clinical test clusters to determine the classification level is good for different testers. 24 The patients' symptoms and onset of the pain mechanism served as the basis for clinical reasoning in the diagnostic decision-making process (Appendix).…”

“…13 Subsequent studies have further refined the existing guidelines for classifying patients with NSLBP using more detailed examination criteria. [14][15][16][17][18] However, to date, there is no consensus on which of the LBP classification systems is more accurate or appropriate in the early phase of LBP, and praxis varies. 9,19 Nevertheless, the question arises as to whether or not PTs can learn to apply a specific classification system for patients with non-specific LPB within the context of a continuing education course.…”

Influence of Directional Preference on Two Clinical Dichotomies: Acute Versus Chronic Pain and Axial Low Back Pain Versus Sciatica

“…Although pain duration and location and neurologic status classes may be useful patient descriptors, pain duration was unable to predict subjects' response to treatment [17,52]. Paatelma et al [67] investigated the ability of clinical tests to distinguish between subacute and chronic LBP and concluded that “subgrouping based on pain duration, as presently recommended by current clinical practice guidelines, may not be an optimal or diagnostically accurate understanding of subjects with chronic or subacute LBP problems.”…”

Clinical reasoning and critical reflection in physiotherapists’ examinations of patients with low back pain in its early phase: a qualitative study from physiotherapists’ point of view

“…With specific pain loading/provocation or pain relieving tests it may be possible to determine from which tissue/structure the nociceptive stimulus is primarily coming. (27,28,(32)(33)(34). Although positive and negative findings of clinical tests do not explain why these tissues/structures are overloaded or strained, they are important when explaining the pain mechanism to patients and when pain treatment for the early phase is designed.…”