TY - JOUR
T1 - The quantified lumbar flexion-relaxation phenomenon is a useful measurement of improvement in a functional restoration program
AU - Mayer, Tom G.
AU - Neblett, Randy
AU - Brede, Emily
AU - Gatchel, Robert Joseph
PY - 2009/10/15
Y1 - 2009/10/15
N2 - Study Design. A prospective cohort study evaluating the quantitative lumbar flexion-relaxation phenomenon (QLFRP), measured with surface electromyographic (SEMG) signals from the erector spinae during trunk flexion pre- and postrehabilitation, in patients with chronic disabling occupational lumbar disorders (CDOLD). ObjectiveS. To assess the responsiveness of the QLFRP in documenting change in functional performance during a functional restoration program for CDOLD patients. Summary of Background Data. A recent theoretical construct suggests that QLFRP is responsive to change in lumbar range of motion (ROM) during rehabilitation, with high sensitivity and specificity for abnormal QLFRP predicting ROM. Methods. A cohort of normal subjects was tested for QLFRP correlated to inclinometric lumbar ROM measures. The cutoff score was applied to a group of CDOLD patients entering a functional restoration program (N = 135), and to program completers (N = 104). Pain and functional self-report scores were compared with SEMG and ROM measures. Results. The CDOLD group averaged 23.7 months off work. Surgical treatment was provided prerehabilitation to 51% of patients, with 29% receiving lumbar fusions. From pre- to post-treatment, achievement of QLFRP rose from 31% to 74% of patients, while normal ROM rose from 8% to 63% of patients. Compared to the 16% of patients still demonstrating both abnormal QLFRP and ROM, the other groups showed significantly greater improvement in self-reported pain and function, with the best improvements occurring in patients showing normal ROM and QLFRP. The QLFRP showed high sensitivity, but only modest predictive validity and specificity for predicting ROM postrehabilitation. Improvement in sensitivity and predictive validity occur when surgical cases were excluded from the analysis. Conclusion. A majority of patients in an interdisciplinary functional restoration program failed to demonstrate either the QLFRP or normal ROM on admission to the program. A majority of program completers, however, achieved both normal ROM and QLFRP and another 30% demonstrated either normal QLFRP or normal ROM. Both QLFRP and ROM measures were responsive to relevant self-report scales.
AB - Study Design. A prospective cohort study evaluating the quantitative lumbar flexion-relaxation phenomenon (QLFRP), measured with surface electromyographic (SEMG) signals from the erector spinae during trunk flexion pre- and postrehabilitation, in patients with chronic disabling occupational lumbar disorders (CDOLD). ObjectiveS. To assess the responsiveness of the QLFRP in documenting change in functional performance during a functional restoration program for CDOLD patients. Summary of Background Data. A recent theoretical construct suggests that QLFRP is responsive to change in lumbar range of motion (ROM) during rehabilitation, with high sensitivity and specificity for abnormal QLFRP predicting ROM. Methods. A cohort of normal subjects was tested for QLFRP correlated to inclinometric lumbar ROM measures. The cutoff score was applied to a group of CDOLD patients entering a functional restoration program (N = 135), and to program completers (N = 104). Pain and functional self-report scores were compared with SEMG and ROM measures. Results. The CDOLD group averaged 23.7 months off work. Surgical treatment was provided prerehabilitation to 51% of patients, with 29% receiving lumbar fusions. From pre- to post-treatment, achievement of QLFRP rose from 31% to 74% of patients, while normal ROM rose from 8% to 63% of patients. Compared to the 16% of patients still demonstrating both abnormal QLFRP and ROM, the other groups showed significantly greater improvement in self-reported pain and function, with the best improvements occurring in patients showing normal ROM and QLFRP. The QLFRP showed high sensitivity, but only modest predictive validity and specificity for predicting ROM postrehabilitation. Improvement in sensitivity and predictive validity occur when surgical cases were excluded from the analysis. Conclusion. A majority of patients in an interdisciplinary functional restoration program failed to demonstrate either the QLFRP or normal ROM on admission to the program. A majority of program completers, however, achieved both normal ROM and QLFRP and another 30% demonstrated either normal QLFRP or normal ROM. Both QLFRP and ROM measures were responsive to relevant self-report scales.
KW - Chronic disabling occupational lumbar disorders
KW - gross lumbar motion
KW - hip motion
KW - low back pain
KW - maximum voluntary flexion
KW - quantified lumbar flexion-relaxation phenomenon
KW - surface electromyography
KW - true lumbar flexion
UR - http://www.scopus.com/inward/record.url?scp=75549084231&partnerID=8YFLogxK
U2 - 10.1097/BRS.0b013e3181b20070
DO - 10.1097/BRS.0b013e3181b20070
M3 - Article
C2 - 19789467
AN - SCOPUS:75549084231
SN - 0362-2436
VL - 34
SP - 2458
EP - 2465
JO - Spine
JF - Spine
IS - 22
ER -