Physical progress and residual impairment quantification after functional restoration. Part I: Lumbar mobility

Quantification of human performance in chronic low back pain (CLBP) patients is essential to initiate effective treatment and guide progress in a disability-oriented functional restoration program, as well as to objectively evaluate impairment and functional limitations at the time of maximum medical improvement. One such important measure of physical ability is range of motion. Patients who suffer from CLBP almost invariably have some disturbance of mobility. The major goals of the present study were to: 1) develop a database of anticipated range of motion levels at different points in time in a representative sample of CLBP patients; 2) within the sample, determine any gender or spinal surgery-induced differences; 3) evaluate change in range of motion produced by participation in a comprehensive functional restoration treatment program; and 4) identify residual impairment of regional range of motion. Four separate groups of CLBP patients were evaluated: Group 1 (n = 92), unoperated men; Group 2 (n = 26), postdiscectomy men; Group 3 (n = 59), unoperated women; and Group 4 (n = 17) postdiscectomy women. Patients in each group were assessed for spinal range of motion measures at three points in time, for sagittal/coronal motion and validity (employing the relationship between pelvic motion and supine leg raising). Results demonstrated dramatic patient improvements in range of motion from initial referral to program completion. The most significant gains were made in pelvic motion, which returned to near normal levels, indicating that the vast majority overcame low effort or movement inhibition produced by pain or fear of injury.(ABSTRACT TRUNCATED AT 250 WORDS)