Spinal Mobility Measures Research Articles

Clinical assessment of spinal mobility measurements in ankylosing spondylitis: a compact set for follow-up and trials?

Different spinal ranges of motion (ROM) were measured and the results of 17 repeated tests correlated with spinal radiological changes in 52 male patients with ankylosing spondylitis (AS). Both Schober tests and measurements of lumbar and cervical rotations (TRi, TR, CR, CRt) and lateral flexions (LFLf, LFLx, CLFLt, CLFLm), together with thoracolumbar flexion (ThFL), cervical flexion-extension measurements (CFL, CExt), and tragus - wall and occiput - wall distances (OWD,TWD), showed significant correlations with detailed radiological spinal changes. Cervical rotation (CRm, CRt) and flexion (CFLm) correlated only with cervical changes, and thoracolumbar rotation as assessed by instrument (TRi) correlated only weakly with lumbar changes, while chin-chest distance (CCD) and chest expansion (CE) showed no correlation. Inter- and intratester reliability was good in all tests (the intraclass correlation coefficients ranged from 0.84 to 0.98). Three new tape methods for measuring thoracolumbar and cervical rotations and cervical lateral flexion also proved to be valid and reliable, as did the Schober-S1 modification. We conclude that the thoracolumbar segment (Schober), whole (ThFL) and lateral (LFL) flexions and rotation (TR), and chest expansion (CE) (after careful standardisation) together with cervical rotation (CR), extension (CExt) and/or lateral flexion (CLFL) comprise the set of mobility tests for the follow-up and assessment of disease progression in AS. On the other hand, cervical (forward) flexion (CFL), chin-chest distance (CCD) and an instrument method for thoracolumbar rotation (TRi) are not approaches to be recommended.

A comparison of two motion analysis devices used in the measurement of lumbar spinal mobility

Objective. The aim of the study was to compare lumbar range of motion determined using two computerised dynamic motion analysis devices. Background. Measures of spinal motion are currently used in biomechanical, epidemiological and clinical studies of the low back. It is essential that the various devices used to measure mobility yield similar results, particularly when the absolute values are to be used to assess job suitability, the extent of injury or the need for rehabilitation. Methods. Eleven volunteers took part. The ranges of lumbar flexion, extension, lateral bending and axial rotation were measured using the CA6000 Spine Motion Analyser and the Polhemus Fastrak system, using standardised protocols. Results. Each device showed good test-retest reliability in itself ( R > 0.82). The absolute values for range of flexion in a standing posture were significantly higher with the CA6000 than with the Fastrak (though well correlated); those recorded in sitting were comparable for the two devices. Values for lateral bending using the two devices were well correlated, although small (but significant) differences in the absolute values were found. For extension and axial rotation, the devices gave significantly different values that were also poorly correlated. The ‘limits of agreement’ for the two devices (calculated to examine whether they could be used interchangeably) were rather wide, especially for extension and axial rotation. Conclusion. The two devices do not always yield comparable measures for spinal mobility. The accuracy of each, in relation to true angular movements of the vertebrae, remains unknown. Relevance The two computerised motion analysis devices can each be used reliably in longitudinal studies. However, if ‘normal’ values for spinal mobility are to be established, they must be considered device-specific.

Disability in ankylosing spondylitis

Purpose: This study was designed to examine the functional loss in ankylosing spondylitis and explore the relationship between disability and various factors such as age, disease duration, disease activity, spinal mobility, chest expansion, peripheral joint involvement, radiological changes, and psychosocial well-being. Method: Forty-two patients were included in this crosssectional study. Results: The results showed that 37 patients had mild to moderate disability, two patients had severe disability, and three patients did not report any functional loss. Spearman correlation analyses showed that disability was strongly correlated with spinal mobility measures, disease activity measures, and disease duration. Also, patients with peripheral joint involvement had greater disability. When the predictive effect of five independent variables was studied by multiple regression analysis, it was found that the most powerful predictors of functional loss in AS patients were cervical rotation, modified Schober's test, and pain. Conclusions: These data suggest that functionalconsequences of AS are constituted by multiple impairments and each needs to be managed by an integrated physiatric approach.

Functional and clinical results after anterior interbody lumbar fusion.

The functional and clinical results of anterior interbody lumbar fusion were assessed in 134 patients. Functional tests included spinal mobility and isokinetic trunk muscle strength measurements. The score rating system of the Japanese Orthopaedic association (JOA) and the Oswestry disability index were used for clinical evaluation. Functional results revealed decreased spinal flexibility when compared with normal values. A reduction in physical ability was also seen in the isokinetic trunk muscle measurements. Non-union seemed to have only little effect on the functional results. Patients under 20 years at operation had the best results, but beyond this threshold results did not vary with age. The JOA rating score was 25 or more in 50% of patients. The mean Oswestry disability index was 47.8 (range 1-82) preoperatively and 20 (range 0-68) at follow-up (P < 0.001), indicating a clear decrease in subjective disability. Solid fusion was seen in 107 patients (80%) at follow-up.

The relative value of spinal and thoracic mobility measurements in ankylosing spondylitis.

The relative value of nine spinal and thoracic mobility measurements was investigated in 73 male patients with ankylosing spondylitis (AS). The value of a test was obtained by the relative ranks of validity, reliability and sensitivity to change. Validity was determined as age-adjusted correlation of the test result with AS-specific radiological changes in the lumbar spine. Reliability was determined as inter-observer error. Sensitivity to change was determined as change in test result during an intensive rehabilitation course. The five most valuable tests were rotation of the thoracolumbar spine (TR), finger-to-floor distance (FFD), the Schober test, thoracolumbar flexion and occiput-to-wall distance. Of these, FFD had high reliability and sensitivity ranks, but poor correlation with AS-specific spinal changes. TR had high validity and sensitivity ranks, and improvement of the measurement technology would probably result in a superior test for the follow-up of AS. Chest expansion and vital capacity had low ranks in all comparisons.

Outcome of a multimodal treatment including intensive physical training of patients with chronic low back pain.

A comprehensive 4-week inpatient treatment including intensive physical training was evaluated in 194 chronic low back pain patients of whom 101 were working and 79 were on sick leave. Physical performance was assessed by measurements of spinal mobility, isometric trunk flexion and extension strength, and isokinetic lifting strength. Outcome was evaluated by a functional capacity index and work status changes reported at a 12-month follow-up. There was a 30-50% average increase in physical performance during treatment. At the 12-month follow-up the functional capacity index showed an average increase from 35.4 to 39.3 points (score range 24-48). At follow-up 28% of the sicklisted patients had returned to work and of those employed before treatment 14% were on sick leave. Associations between outcome and the improvement in physical measurements and their level at discharge were determined by stepwise multiple and logistic regression analyses. Among the physical measurements only increase in spinal mobility was associated with functional capacity index in women and return to work in both men and women at the 12-month follow-up. The overall results showed that intensive physical training and improved physical performance did not play crucial roles in the rehabilitation of chronic low back pain patients, at least when return to work was used as the outcome criterion.

Effects and follow-up of a multimodal treatment program including intensive physical training for low back pain patients

The results of a comprehensive 4-week treatment program including intensive physical training were evaluated in 65 chronic low back pain patients. Marked increases in measures of spinal mobility, trunk muscle strength and lifting capacity were found during the treatment, but no average increase in pain ratings. At 3-week and 12-month follow-ups a statistically significant decrease in subjective disability and pain was found, but the percentage of patients who were working was unchanged. This points to a need for more work-oriented rehabilitation efforts in the treatment.

Measurement of spinal sagittal configuration and mobility with Debrunner's kyphometer.

A considerable number of instruments have been described for noninvasive measurements of the sagittal configuration and mobility of the thoracolumbar spine. With Debrunner's kyphometer, it is possible to obtain this information in approximately 1 minute in a clinical setting. A minor modification of the kyphometer to increase its range of measurement of lumbar extension is described. Repeatability of measurements with the instrument was studied on 31 healthy individuals in a randomized cross-over model. In another study, ten individuals were examined ten times each by the same investigator within 3 weeks. These studies showed good reproducibility for measurements with the kyphometer. The importance of standardized instructions for measurement procedures is emphasized. The statistical approach to repeatability of measurements is discussed.

Comparison between tape measurements of forward and lateral flexion of the spine

Forward and lateral flexion measures of spinal mobility were obtained with both inclinometric and tape methods from 476 low back pain patients. The tape measurements were compared as to correlation with a score of back pain-related disability. Tape measurement methods were compared with inclinometric measurements, and the relative effects of height, weight, lordosis, and kyphosis were established. Lateral flexion, measured as the distance the hand moves down the thigh, correlated better with corresponding inclinometric measurements and with the degree of back pain-related disability than forward flexion measured with skin distension methods. Tape measurements of forward flexion but not that of lateral flexion were significantly affected by weight and lordosis. The results indicate that tape measurement of lateral flexion is preferable to those of forward flexion in assessment of low back pain patients.

Correlations of spinal mobility with degree of chronic low back pain after correction for age and anthropometric factors.

Correlations of age, height, weight, lordosis, and kyphosis with noninvasive spinal mobility measurements were studied in 301 men and 175 women, aged 35-55 years, who suffered from chronic or recurrent low back pain (LBP). Correlations of the different spinal movements with the degree of LBP were analyzed, with corrections for these relationships. Age had significant indirect correlations with most of the mobility measurements, but the effect of height was minor. Weight had considerable negative correlations with the mobility measurements, except lateral flexion. Lordosis and kyphosis had significant relationships with mobility in the sagittal and frontal planes. Correction for the factors analyzed only slightly reduced the correlations between spinal mobility and LPB. Thoracolumbar mobility had higher correlations with LBP than mobility of the lumbar spine. Thoracal spinal mobility alone also correlated with LBP. Lateral flexion and rotation, except for rotation in women, had stronger relationships than forward flexion and extension with LBP.

The effect of the Swedish Back School in chronic idiopathic low back pain. A prospective controlled study

A prospective controlled study of the effect of the Swedish Back School in chronic idiopathic Low Back Pain was conducted. Forty-eight patients entered the study. There were no significant pre-treatment differences between the experimental group members who attended the four lessons of the Back School, and the control group who received four detuned shortwave applications to the low back. Forty-three patients (21 in the experimental and 22 in the control group) completed the study. Subjects were repeatedly tested for one year. The following assessments were made: 1) subjective scores of pain and functional capacity, and 2) objective measurements of spinal mobility. After one year, no statistically significant differences between the two groups were observed. Given the proven efficacy of the Back School in (sub)acute Low Back Pain, it should be administered when it is most beneficial, i.e. in the early phase of Low Back Pain.

Sulindac in Ankylosing Spondylitis

Ankylosing spondylitis affects about 1% of the population. In the past, evaluation of therapy in the management of this disease has been hampered by the lack of availability of objective criteria for following the condition. By using recently developed measurements of spinal mobility and other variables we have compared sulindac, a recently introduced nonsteroidal antiinflammatory drug, and indomethacin in a double-blind six-month parallel study of 30 patients. Sulindac and indomethacin have comparable efficacy and tolerance. Advantages of sulindac include a twice-a-day dose regimen.

Measurement of spinal mobility.

Measurement of spinal mobility.