Directional preference constructs for patients’ low back pain in the absence of centralization

Abstract

Objectives: A detailed description of how Directional Preference (DP) constructs are measured could accelerate research to practice translation and improve research findings for Mechanical Diagnosis and Therapy (MDT) stakeholders. A secondary analysis of a prospective, observational cohort study was conducted to understand (1) the type and prevalence of DP constructs at first examination and (2) the relationships between DP constructs and clinical outcomes at follow-up. Methods: Data were collected and analyzed from 1485 consecutive patients who presented to outpatient, private practice clinics with primary complaints of non-specific low back pain (LBP); 400 patients met the inclusion criteria and completed first examination and follow-up data. Statistical analysis determined prevalence and the relationships between DP constructs at first examination and clinical outcomes at follow-up. Results: The primary findings in this investigation were that (1) the most prevalent DP constructs at first examination were related to range of motion (ROM) and pain intensity (Patient Reported Improvement in ROM (74.8%), Increase in Spine ROM (29.5%), and Pain Intensity Change (17.3%)), (2) all groups improved and made clinically meaningful improvements in disability and pain intensity at follow-up, (3) no clinically significant differences in disability or pain intensity were found between the groups at follow-up, and (4) 26.5% and 6.5% of patients exhibited a relative increase in lumbar spine extension and flexion ROM, respectively, post repeated movement testing on the first examination. Discussion: The findings in this study assist providers in making assessment and treatment decisions with their patients by offering insight regarding the most prevalent DP constructs typically found at the first examination and their subsequent association with outcome when Centralization (CEN) does not occur. Recommendations for researchers have been made to further explore the DP framework used in this study.

Does the Keele STarT Back Screening Tool Contribute to Effectiveness in Treatment and Cost and Loss of Follow-Up of the Mechanical Diagnosis and Therapy for Patients with Low Back Pain?

“…In MDT, there are three primary subgroups for the spinal problem, and the inter-examiner reliability for the subgroups has been established among credentialed MDT therapists [ 19 ]. The most prevalent subgroup is for derangement syndrome [ 20 , 21 , 22 , 23 , 24 ]. The derangement syndrome subgroup has a specific direction of loading, resulting in functional improvement and pain, which is called a directional preference (DP).…”

“…When time and sessions until discharge from the MDT are considered, it is also important to remember that there are some patients who lose follow-ups before identifying effective management strategies. We have known that a long duration of LBP and many comorbidities [ 21 , 22 ] are contributing factors for the loss of MDT follow-up; however, no study has investigated whether the medium-high-risk group in SBST can also be included as a contributing factor. In the MDT for the spinal problem, the subgroup was identified within five sessions [ 31 ].…”