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.

KEYWORDS:

• Lumbar spine
• low back pain
• directional preference
• McKenzie
• centralization
• practice-based evidence
• orthopedic
• musculoskeletal

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Richard Yarznbowicz

Richard Yarznbowicz obtained his doctor of physical therapy from the University of the Sciences in Philadelphia in 2010 before earning his diploma in Mechanical Diagnosis and Therapy in 2013. He is also a board certified Orthopedic Clinical Specialist. He has authored and co-authored several publications regarding the assessment and treatment of patients with musculoskeletal disorders.

Minjing Tao

Minjing Tao is an Assistant Professor of Statistics at The Florida State University. She earned her Ph.D. in Statistics from UW-Madison in 2013. Her research interests have included high dimensional data analysis, financial time series, and statistical inference for high-frequency financial data.