Validity of increasing the number of motor control tests within a test battery for discrimination of low back pain conditions in people attending a physiotherapy clinic: a case-control study

BMJ Open. 2019 Nov 25;9(11):e032340. doi: 10.1136/bmjopen-2019-032340.

Abstract

Objectives: To develop a time-efficient motor control (MC) test battery while maximising diagnostic accuracy of both a two-level and three-level classification system for patients with non-specific low back pain (LBP).

Design: Case-control study.

Setting: Four private physiotherapy practices in northern Germany.

Participants: Consecutive males and females presenting to a physiotherapy clinic with non-specific LBP (n=65) were compared with 66 healthy-matched controls.

Primary outcome measures: Accuracy (sensitivity, specificity, Youden index, positive/negative likelihood ratio, area under the curve (AUC)) of a clinically driven consensus-based test battery including the ideal number of test items as well as threshold values and most accurate items.

Results: For both the two and three-level categorisation system, the ideal number of test items was 10. With increasing number of failed tests, the probability of having LBP increases. The overall discrimination potential for the two-level categorisation system of the test is good (AUC=0.85) with an optimal cut-off of three failed tests. The overall discrimination potential of the three-level categorisation system is fair (volume under the surface=0.52). The optimal cut-off for the 10-item test battery for categorisation into none, mild/moderate and severe MC impairment is three and six failed tests, respectively.

Conclusion: A 10-item test battery is recommended for both the two-level (impairment or not) and three-level (none, mild, moderate/severe) categorisation of patients with non-specific LBP.

Keywords: case-control study; low back pain; motor control; movement control impairment.

Publication types

  • Multicenter Study
  • Validation Study

MeSH terms

  • Adult
  • Case-Control Studies
  • Female
  • Germany
  • Humans
  • Low Back Pain / classification
  • Low Back Pain / diagnosis*
  • Low Back Pain / physiopathology*
  • Male
  • Middle Aged
  • Motor Skills
  • Movement Disorders / diagnosis
  • Movement*
  • Pain Measurement / methods*
  • Physical Therapy Modalities
  • ROC Curve