Physical progress and residual impairment quantification after functional restoration: Part i: Lumbar mobility

Qualification of human performance in chronic low back pain (CLBPI patients Is essential to initiate effective treatment and guide progress in a disability-oriented functional restoration program, as well as to objectively evaluate Impairment and functional limitations at the time of maximum medical improvement, Oro such important measure of physical ability is range of motion. Patients who suffer from CLBP almost invariably have SO mo disturbance of mobility. The major goals of the present study were to: 1] develop a database of anticipared range of motion levels at different points in time in a representative sample of CLEiP patients; 1) wi:hin the sample determine any gander ?r Spinal surgery- induced differences; 3) evaluate change in range of motion produced by participation in a comprehensive functional restoration treatment program; and 4 iden- tify residual impairment of regional range of motion. Four separate groups of CLBP patients were evaluated; Group i (n = 92), unoporatcd men; Group 2 (n = 2Qr. pftsldisrteclomy men; Group 3 (n = 59), unopera?ed women; and Group 4 In = 171 postdlscactomy woman. Patients in each group were assessed for spinal range of motion measures atthrao points in time, for sagittal/coronal motion and validity (employing the relationship between pelvic motion and supine leg raising). Results demonstrated dramatic patient Improvements In range of motion from initFal referral to program completion. The moat significant gains were made in pelvic motion, which returned to near normal fevels, indicating that the vast majority overcame IDW effort or movement in¬hibition produced tey pain or fear of injury, Poor sffort initially shown by 20% of patients (PRE) dropped to 3% at post-sturty re-evaluation (FU|. However, biplaner true lumbar mot'on generally remained mildly restricted, moat significantly in the pOStdiscectpmy group, «inaia- tent with a degree of persistent land, possibly, permanent) Impairment of mobility. There were afso no signif-icant differences in final true lumbar flexion/extansior scores between male and female patients., as wee previously snown for normal subjects. In summary, it appears that surgery has more of an effect an patient rt- aponse to functional restoration treatment than gender.Theae data will provide clinicians with a vafuable resource for gauging expcctcd progress In patients undergoing effective functional restoration treatment for disabling CLBP, and will identify expected preireatment motion inhibition end pogMrsetment permanent (or persistent) residua' impairment of regional T12-S1 mobility.