Novel Physical Functioning Test To Complement Subjective Questionnaires In Chronic Low Back Pain Assessments

Abstract

The gold standard for Chronic Low Back Pain (CLBP) evaluation uses self-reported Patient Reported Outcome Measures (PROMs), with Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ) as the most common outcome. Physical Functioning Tests (PFTs) was proposed as a complementary objective outcome measure with no consensus on implementation. PURPOSE: Assess the feasibility of established PFTs that includes Sorensen Test (ST), 5 Repetition Sit-to-stand (5R-STS), Loaded Forward Reach (LFR) for CLBP assessment. Novel Proposed Lift and Place (PLAP) developed based on existing workplace guideline and known risk factors, compared with established PFTs. METHODS: Men and women aged 19 to 55 with and without CLBP would have their PROM and PFT measured. Statistical analysis tests the difference in PFT score between CLBP participant and control, and correlation of PROM and PFT score in CLBP participants, Receiver Operating Characteristic (ROC) curve analysis was done to calculate Area Under the Curve (AUC) of each PFT. CLBP participants’ PROMs and PFTs were measured on separate days to calculate test-retest IntraClass Correlation (ICC) reliability. RESULTS: 83 CLBP participants (32 men and 51 women, mean age: 30.2) and 82 control participants (40 men and 42 women, mean age: 27.4) were recruited. CLBP group (mean 88.1 ± 49.5 s) had less endurance than control (mean 114.1 ± 44.5 s) in ST. CLBP group (mean 8.0 ± 1.8 s) was slower than control (mean 6.8 ± 1.4 s) in 5R-STS. CLBP group (mean 33.6 ± 6.0 cm) had shorter reach than control (mean 36.3 ± 6.6 cm) in LFR. CLBP group (mean 21.6 ± 4.9 s) was slower than control (mean 18.6 ± 3.6 s) in PLAP. 5R-STS was correlated with ODI, r = .506 and RMDQ, r = .341. PLAP was correlated with ODI, r = 0.418, and RMDQ, r = .390. 5R-STS had AUC = .743 and PLAP had AUC = .685 on ROC analysis. All PFT had test-retest ICC > .8, with ST ICC = .925, 5R-STS ICC = .869, LFR ICC = .858 and PLAP ICC = .913. CONCLUSIONS: 5R-STS and PLAP demonstrated weak to moderate correlation with established PROMS and high reliability and can be consider as objective measurement in future CLBP intervention studies to complement subjective PROMS. Further studies can investigate usage of 5R-STS, PLAP and other PFT for quick screening of CLBP disability.