Association between directional preference and centralization in patients with low back pain

Area of Science:

• Clinical Biomechanics
• Musculoskeletal Rehabilitation
• Pain Management

Background:

• Evidence suggests directional preference (DP) and symptom centralization (CEN) criteria improve patient outcomes in low back pain (LBP).
• Previous research has not fully delineated the relationship between DP, CEN findings, and specific patient outcomes.

Purpose of the Study:

• To determine the baseline prevalence of directional preference (DP) or no directional preference (no-DP) in LBP patients.
• To assess the prevalence of centralized (CEN), non-centralized (non-CEN), or unclassifiable (NC) symptoms.
• To evaluate if classifying patients by DP and symptom classification at intake predicts functional status and pain intensity at rehabilitation discharge.

Main Methods:

• A prospective, longitudinal, observational cohort study involving eight therapists.
• Patients were classified using standardized definitions for DP and CEN.
• Multivariate regression models analyzed the predictive value of combined DP/CEN classifications on discharge function and pain.

Main Results:

• Overall prevalence of DP was 60% and CEN was 41%.
• Among patients with DP, 65% were CEN, 27% non-CEN, and 8% NC.
• Classifications of DP/non-CEN and no-DP/non-CEN significantly predicted poorer functional status and higher pain intensity at discharge compared to DP/CEN.

Conclusions:

• Classification based on pain pattern (DP) and symptom response (CEN) is a valuable tool for therapists.
• This classification method improves the ability to provide accurate short-term prognoses for functional status and pain outcomes in LBP patients.