Clinicians who treat low back pain (LBP) are interested in findings that predict the outcome in order to develop treatment plans that will enhance the potential for full recovery. The usual clinical testing procedures include symptom response classification schemes (e.g. centralization/peripheralization) ranges of motion, palpation, provocative testing maneuvers, neurological testing and identification of non-organic signs. A recent systematic review published in Chiropractic & Manual Therapies (open access) assessed the association between these commonly used clinical tests with short- and long-term outcomes.
The review concluded that, with the exception of two, most of these clinical tests have not been adequately evaluated for their associated clinical outcomes. The two tests that seem to be predictive of the clinical outcome were the centralization phenomenon for less short term pain (a positive prognostic indicator) and non-organic signs where three of the five signs were predictive of failure to return to work.
Despite the lack of clear associations between most tests and clinical outcomes, the authors note, “…most clinical tests are designed and used for other purposes, and a poor association with prognosis does not discredit the test as being diagnostic or otherwise informative for clinical management. Clinical tests may still have potential as treatment effect modifiers or as part of comprehensive predictive models.”