Development of Active Hip Abduction as a Screening Test for Identifying Occupational Low Back Pain

Abstract

to develop LBP as the length of time on their feet increases. 15 From an occupal ow back pain (LBP) is a major contributor to increasing healthcare costs in North America, with estimates that 70% to 85% of all adults will experience an acute episode of LBP at some point in their lives. 8 Epidemiological studies have shown that standing occupations have a strong association with LBP.1,25 Checkout clerks and other individuals with occupations requiring long periods of standing are known t STudy deSign: Analytic observational prospective study performed in a controlled laboratory setting.t obJecTiveS: To assess the ability of a new screening tool, the active hip abduction test, to predict low back pain development during prolonged standing in previously asymptomatic individuals.t background: Most screening tools used for a patient with low back pain do not assess the patient's ability to maintain postural control in the frontal plane, when placed in an unstable position. Postural-control differences in pain developers, as compared to non-pain developers, during standing have been found previously. An attempt was made to predict pain development with a simple screening test.t meThodS: Forty-three previously asymptomatic volunteers underwent a clinical assessment prior to a 2-hour standing protocol designed to induce low back pain. Participants rated low back pain with a visual analog scale and were classified into pain developers or non-pain developers.t reSulTS: Forty percent of participants developed low back pain. The active hip abduction test was the only test that discriminated between pain-developer groups. When the examiner scored the test, the odds ratio was 3.85 (95% confidence interval [CI]: 1.05-19.07), and when the test was self-rated, the odds ratio was 6.55 (95% CI: 1.14-37.75) for pain development during standing.t concluSion: The active hip abduction test appears to show promise for predicting individuals who are at risk for low back pain development during prolonged standing. More work is required to validate the test in clinical populations, and to assess interrater and intrarater reliability. t level oF evidence: Diagnosis, level 2b. Ther 2009;39(9):649-657. doi:10.2519/jospt.2009 t key wordS: clinical assessment, diagnostic tests, lumbar spine, stabilization tional safety and health perspective, it would be ideal to have a simple screening tool that could identify "at-risk" workers and guide an appropriate preventative exercise program. J Orthop Sports PhysWhile multiple researchers have identified differences in motor control patterns between patients with LBP and healthy controls, 4,5,7 there have been few prospective studies published to evaluate whether these differences are adaptive to the LBP disorder or are risk factors that might increase the likelihood of pain development. We have previously used a "functionally induced low back pain" model as a prospective design to study factors linked to LBP development during standing. 9,10,23 The main idea behind this protocol is that a percentage ...

Interrater and Intrarater Reliability of the Active Hip Abduction Test

“…and A.M.D.) evaluated each video clip for quality and separately scored each video clip using a modified version of the criteria previously established by Nelson-Wong et al 15 When there was disagreement about a score, the 2 investigators watched the video clip together and identified the key features of the movement, then assigned it a consensus score.…”

“…This approach was used to refine the initial scoring criteria originally reported 15 to improve the clarity of the instructions and description for each scoring category. TABLE 1 reflects the modified scoring criteria as they were provided to each rater.…”

“…14,16 These findings have led to the development of a screening test for identifying individuals at risk of LBP called the active hip abduction (AHAbd) test. 15 Findings from previous research of the AHAbd test revealed that the tool was valuable in discerning in a sample of previously asymptomatic participants those who developed LBP during prolonged standing and those who did not, with a high level of specificity (0.88). 15 The AHAbd test was designed to assess the maintenance of neutral trunk and pelvic alignment in the frontal plane, while the individual performed a single hip abduction movement in a sidelying position.…”

“…15 Findings from previous research of the AHAbd test revealed that the tool was valuable in discerning in a sample of previously asymptomatic participants those who developed LBP during prolonged standing and those who did not, with a high level of specificity (0.88). 15 The AHAbd test was designed to assess the maintenance of neutral trunk and pelvic alignment in the frontal plane, while the individual performed a single hip abduction movement in a sidelying position. The original scoring criteria were based on an ordinal scale ranging from 0 to 3 (0, no difficulty, smooth and controlled movement; 1 minor difficulty, able to correct position; 2, major difficulty, able to correct position; and 3, major difficulty, unable to correct position).…”

Regional Interdependence: A Model That Needs to Be Integrated in the Functional Evaluation and Physiotherapy Treatment—Part 1

“…The elbow pain associated with the shoulder [10]. For the lower quadrant: the Low Back Pain (LBP) might be associated with osteoarthritis of the hip and knee [11]- [13], or related to foot and ankle problems [14]- [18]. Knee pain can be related to hip functional implications [19] [20].…”