Aktuelle Evidenz der Reliabilität und Validität klinischer Tests zur Evaluation der Bewegungskontrolle bei lumbalen Rückenschmerzen

Zusammenfassung

Im klinischen Alltag stehen eine verminderte lumbale Bewegungskontrolle und unspezifische Rückenschmerzen häufig in Zusammenhang.

Das Ziel der systematischen Übersichtsarbeit war es, die aktuelle Evidenz der diagnostischen Gütekriterien klinischer Bewegungskontrolltests bei Patienten mit lumbalen Rückenschmerzen zu ermitteln und die zuverlässigsten Tests oder Testkombinationen zu identifizieren, um Empfehlungen für die Praxis zu geben.

Die Analyse der einzelnen Gütekriterien der ausgewählten 23 Tests und deren Kombinationen zeigte sehr variable Ergebnisse. Bei einem Großteil der Tests ließen sich für die Reliabilität ausreichend gute Ergebnisse hinsichtlich der diagnostischen Wertigkeit und klinischen Anwendbarkeit nachweisen.

Aufgrund ungenügender Evidenz zur diskriminativen Validität zwischen gesunden Personen und Patienten mit Rückenschmerzen sind Bewegungskontrolltests und deren Kombinationen aktuell nur bedingt zu empfehlen. Jeder angewandte klinische Test/Testkombination sollte standardisiert durchgeführt und wegen fehlender einheitlicher Beurteilungskriterien nur im Kontext mit den Anamnesedaten und weiteren physischen Untersuchungsbefunden bewertet werden.

Abstract

A correlation between reduced lumbar movement control and unspecific back pain is often found in clinical practice.

The aim of this systematic literature review was to identify the current evidence of diagnostic performance criteria of movement control tests in patients with lumbar back pain as well as the most reliable tests or test combinations in order to give daily practice recommendations.

The analysis of the individual performance criteria of the selected 23 tests and their combinations showed variable results. Adequate reliability for the diagnostic value and clinical feasibility could be shown for most of the tests.

There is currently insufficient evidence concerning the discriminant validity between healthy subjects and patients with back pain of movement control tests and their combinations. They can therefore only be recommended conditionally.

Each applied clinical test/test combination should be performed standardized. Due to the lack of consistent evaluation criteria they should only be evaluated in the context of the individual case history and additional physical examination findings.

Schlüsselwörter

unspezifischer Rückenschmerz - lumbale Instabilität - Bewegungstests - Bewegungskontrolltests - motorische Kontrolltests - Reliabilität - Sensitivität - Spezifität - Validität

Keywords

unspecific back pain - lumbar instability - movement tests - movement control tests - motor control tests - reliability - sensitivity - specificity - validity

• Literatur

• 1 Airaksinen O, Brox JI, Cedraschi C et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15 (Suppl. 02) S192-S300
• 2 Andersson GBJ. Epidemiology of low back pain. Acta Orthop Scand Suppl 1998; 281: 28-31
• 3 Bergmark A. Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop Scand Suppl 1989; 230: 1-54
• 4 Beyerlein C. Editorial. Klassifikationen. manuelletherapie 2013; 17: 193
• 5 Billis E, Mc Carthy C, Oldham J. Subclassification of low back pain: across country comparison. Eur Spine J 2007; 16: 865-879
• 6 Bogduk N. Klinische Anatomie von Lendenwirbelsäule und Sakrum. Berlin: Springer; 2000
• 7 Bolten W, Kempel-Waibel A, Pforringer W. Analyse der Krankheitskosten bei Rückenschmerzen. Med Klin 1998; 93: 388-393
• 8 Bruno PA, Millar DP, Goertzen DA. Inter-rater agreement, sensitivity, and specificity of the prone hip extension test and active straight leg raise test. Chiropractic and Manual Therapies 2014; 1: 22
• 9 Comerford MJ, Mottram SL. Functional stability re-training: principles and strategies for managing mechanical dysfunction. Manual Therapy 2001; 6: 3-14
• 10 Dankaerts W, O’Sullivan PB, Straker LM et al. The inter-examiner reliability of a classification method for non-specific chronic low back pain patients with motor control impairment. Manual Therapy 2006; 11: 28-39
• 11 Davis AM, Bridge P, Miller J et al. Interrater and intrarater reliability of the active hip abduction test. J Orthop Sports Phys Ther 2011; 41: 953-960
• 12 Deutsche Gesellschaft für Unfallchirurgie (DGU). Pressestelle: Volkskrankheit Rückenschmerz. 2008 www.dgu online.de/pdf/allgemeines/presse/PK_Volkskrankheit_Rueckenschmerz_2008 (14.02.2009)
• 13 Van Dillen LR, Sahrmann SA, Norton BJ et al. Reliability of physical examination items used for classification of patients with low back pain. Phys Ther 1998; 78: 979-988
• 14 Dionne CE, Dunn KM, Croft PR et al. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine 2008; 33: 95-103
• 15 Enoch F, Kjaer P, Elkjaer A et al. Inter-examiner reproducibility of tests for lumbar motor control. BMC Musculoskelet Disord 2011; 12: 114
• 16 Flor H, Braun C, Elbert T et al. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neurosci Lett 1997; 224: 5-8
• 17 Frank W. Textskriptum – Biostatistik. Krems: Donau Universität; 2013
• 18 Fritz JM, Brennan GP, Clifford SN et al. An examination of the reliabilitiy of a classification algorithm for sub-grouping patients with low back pain. Spine 2006; 31: 77-82
• 19 Gilad I, Nissan M. Saggital evaluation of elemental geometrical dimensions of human vertebrae. J Anat 1985; 143: 115-120
• 20 Gombatto SP, Collins DR, Sahrmann SA et al. Patterns of lumbar region movement during trunk lateral bending in 2 subgroups of people with low back pain. Phys Ther 2007; 4: 441-454
• 21 Hardcastle P, Nade S. The significance of the Trendelenburg test. J Bone Joint Surg 1985; 67: 741-746
• 22 Hellems HK, Keates TE. Measurements of the normal lumbosacral angle. Am J Roentgenol 1971; 113: 642-645
• 23 Hicks G, Fritz J, Delitto A et al. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil 2005; 86: 1753-1762
• 24 Hochschild J. Strukturen und Funktionen begreifen: Funktionelle Anatomie – therapierelevante Details. Stuttgart: Thieme; 2002
• 25 Hodges PW, Richardson CA. Contraction of the abdominal muscles associated with movement of the lower limb. Physical Therapy 1997; 77: 132-144
• 26 Hodges PW. Is there a role for transversus abdominis in lumbo pelvic stability?. Manual Therapy 1999; 4: 72-86
• 27 Hodges P, Richardson CA. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Archives of Physical Medicine and Rehabilitation 1999; 80: 1005-1012
• 28 Hopewell S, Loudon K, Clarke M et al. Publication bias in clinical trials due to statistical significance or direction of trial results. Cochrane Database Syst Rev 2009; (1) MR000006
• 29 Jensen MC, Brant-Zawadzki MN, Obuchowski N et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994; 331: 69-73
• 30 Kapandji IA. Funktionelle Anatomie der Gelenke. Stuttgart: Thieme; 2009
• 31 Kjaer P, Leboeuf-Yde C, Korsholm L et al. Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine 2005; 30: 1173-1180
• 32 Klittmann S, Morrison F. Klassifikationssysteme zur Kategorisierung von Patienten mit lumbalen Rückenschmerz. manuelletherapie 2013; 17: 206-215
• 33 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
• 34 Lucas NP, Macaskill P, Irwig L et al. The development of a quality appraisal tool for studies of diagnostic reliability (QAREL). J Clin Epidemiol 2010; 63: 854-861
• 35 Lucas N, Macaskill P, Irwig L et al. The reliability of a quality appraisal tool for studies of diagnostic reliability (QAREL). BMC Med Res Methodol 2013; 13: 111
• 36 Ludwig J, Kramer J. Low back pain. Der Orthopäde 2002; 31: 337-341 quiz: 342–333
• 37 Luomajoki H, Kool J, de Bruin ED et al. Reliability of movement control tests in the lumbar spine. BMC Musculoskelet Disord 2007; 8: 90
• 38 Luomajoki H, Kool J, de Bruin ED et al. Movement control tests of the low back; evaluation of the difference between patients with low back pain and healthy controls. BMC Musculoskelet Disord 2008; 9: 170
• 39 Luomajoki H. Movement control impairment as a sub-group of non-specific low back pain – evaluation of movement control test battery as a practical tool in the diagnosis of movement control impairment and treatment of this dysfunction [Dissertation]. Kuopio: University of Eastern Finland; 2010
• 40 Luomajoki H, Moseley GL. Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls. Br J Sports Med 2011; 45: 437-440
• 41 Luomajoki H. Sechs Richtige: Mit der Testbatterie die lumbale Bewegungskontrolle untersuchen. manuelletherapie 2012; 16: 220-225
• 42 Mangold S. Evidenzbasiertes Arbeiten in der Physiotherapie. Heidelberg: Springer; 2011
• 43 Mayer H, van Hilten E. Einführung in die Physiotherapieforschung. Wien: Facultas; 2007
• 44 Mehrholz J, Supp G. Wissenschaft transparent – Klinische Studien verstehen. Rosshaupten: McKenzie Institut; 2010
• 45 Mens JM, Vleeming A, Snijders CJ et al. Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine 2001; 26: 1167-1171
• 46 Meziat Filho N. Changing beliefs for changing movement and pain: Classification-based cognitive functional therapy (CB-CFT) for chronic non-specific low back pain. Manual Therapy 2016; 21: 303-306
• 47 Van Minnen JH. Funktionelle lumbale Instabilität. In: Westerhuis P, Wiesner R. Klinische Muster in der Manuellen Therapie. Stuttgart: Thieme; 2011
• 48 Monnier A, Heuer J, Norman K et al. Inter- and intra-observer reliability of clinical movement-control tests for marines. BMC Musculoskelet Disord 2012; 13: 263
• 49 Murphy DR, Byfield D, McCarthy P et al. Interexaminer reliability of the hip extension test for suspected impaired motor control of the lumbar spine. J Manipulative Physiol Ther 2006; 29: 374-377
• 50 Nelson-Wong E, Flynn T, Callaghan JP. Development of active hip abduction as a screening test for identifying occupational low back pain. J Orthop Sports Phys Ther 2009; 39: 649-657
• 51 O’Sullivan P. Masterclass. Lumbar segmental instability: clinical presentation and specific stabilizing exercise management. Manual Therapy 2000; 5: 2-12
• 52 O’Sullivan P. Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism. Manual Therapy 2005; 10: 242-255
• 53 Oesch P, Hilfiker R, Kool J et al. Assessments in der Rehabilitation. Bern: Huber; 2011
• 54 Panjabi MM. The stabilizing system of the spine. Part I: Function, dysfunction, adaptation and enhancement. J Spinal Disord 1992; 5: 383-389
• 55 Panjabi MM. The stabilizing system of the spine. Part II: Neutral zone and instability hypothesis. J Spinal Disord 1992; 5: 390-397
• 56 Pearcy MJ, Tibrewal SB. Axial rotation and lateral bending in the normal lumbar spine measured by three-dimensional radiography. Spine 1984; 9: 582-587
• 57 Pearcy MJ. Stereo-radiography of lumbar spine motion. Acta Orthop Scandinav Supp 1985; 212: 1-41
• 58 Pfund R, Zahnd F. Leitsymptom Schmerz. Stuttgart: Thieme; 2003
• 59 Phillips B, Ball C, Sackett D et al. Oxford Center for Evidence-based Medicine – Levels of Evidence. 03/2009 www.cebm.net/index.aspx?o=1025 (29.01.2014)
• 60 Pitkanen M, Maninnen HI, Lindger KA et al. Limited usefulness of traction-compression films in the radiographic diagnosis of lumbar spinal instability: comparison with flexion-extension films. Spine 1997; 22: 193-197
• 61 Rabin A, Shashua A, Pizem K et al. The interrater reliability of physical examination tests that may predict the outcome or suggest the need for lumbar stabilization exercises. Journal of Orthopaedic and Sports Physical Therapy 2013; 43: 83-90
• 62 Rauber A, Kopsch F. Anatomie des Menschen. Stuttgart: Thieme; 1998
• 63 Rogan S. Klassifikationen in der Physiotherapie am Beispiel Rückenschmerz. manuelletherapie 2013; 17: 201-205
• 64 Roussel NA, Nijs J, Truijen S et al. Low back pain: clinimetric properties of the Trendelenburg test, active straight leg raise test, and breathing pattern during active straight leg raising. J Manipulative Physiol Ther 2007; 30: 270-278
• 65 Sahrmann SA. Diagnosis and treatment of movement impairment syndromes. St. Louis: Mosby; 2002
• 66 Saner J, Kool J, Sieben JM et al. A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: A randomized controlled trial with one-year follow-up. Manual Therapy 2015; 20: 672-679
• 67 Schmidt CO, Kohlmann T. Was wissen wir über das Symptom Rückenschmerz? Epidemiologische Ergebnisse zu Prävalenz, Inzidenz, Verlauf, Risikofaktoren. Z Orthop Ihre Grenzgeb 2005; 143: 292-298
• 68 Schmidt CO, Kohlmann T. Rückenschmerzen in Deutschland – ein epidemiologischer Überblick. Gesundheitsberichte Spezial. Band 5: Rückengesundheit fördern und verbessern 10/2008 www.lzg.gc.nrw.de/_media/pdf/gesundheitberichtedaten/gesundheitsberichtenrw-spezial/gesundheit-spezial_band-5_rueckengesundheit (15.03.2014)
• 69 Schmorl G, Junghans H. The human spine in health and disease. New York: Grune & Stratton; 1971
• 70 Schomacher J. Diagnostik und Therapie des Bewegungsapparates in der Physiotherapie. Stuttgart: Thieme; 2001
• 71 Scientific Advisory Committee of the Medical Outcome Trust. Assessing health status and quality of life instruments: Attributes and review criteria. Qual Life Res 2002; 11: 193-205
• 72 Simopoulos TT, Manchikanti L, Singh V et al. A systematic evaluation of prevalence and diagnostic accuracy of sacroiliac joint interventions. Pain Physician 2012; 15: E305-E344
• 73 Tidstrand J, Horneij E. Inter-rater reliability of three standardized functional tests in patients with low back pain. BMC Musculoskelet Disord 2009; 10: 58
• 74 Vibe Versum K, O’Sullivan PB, Kvale A et al. Inter-examiner reliability of a classification system for patients with non specific low back pain. Man Ther 2009; 14: 555-561
• 75 Waddell G. The Back Pain Revolution. Edinburgh: Churchill Livingstone; 2004
• 76 Wenig CM, Schmidt CO, Kohlmann T et al. Costs of back pain in Germany. Eur J Pain 2009; 13: 280-286
• 77 Whiting P, Rutjes AWS, Reitsma JB et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Medical Research Methodology 2003; 3: 25
• 78 Whiting PF, Weswood ME, Rutjes AWS et al. Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Medical Research Methodology 2006; 6: 9