Cherniack M, Dillon C, Erdil M, Ferguson S, Kaplan J, Krompinger J, Litt M, Murphy M
Ergonomics Technology Center of Connecticut, University of Connecticut Health Center, Farmington, CT 06030, USA.
Spine J. 2001 Jul-Aug;1(4):290-8. doi: 10.1016/s1529-9430(01)00104-8.
Low back pain (LBP) and low back disorders (LBDs) identify a complex constellation of conditions that frustrate both diagnosis and therapy. Dynamic quantitative assessment and questionnaire instruments directed toward psychosocial and situational variables provide potentially powerful tools for determining functional pathology and potentially outcome.
Our goal was to independently assess clinical correlates of a trunk motion measurement device, the lumbar motion monitor (LMM). The reliability of the LMM as a clinical test was assessed by comparison with an independent medical examination and biobehavioral questionnaires.
STUDY DESIGN/SETTING: There were three study components. A multispecialty physician panel that administered a structured physical examination contributed to a clinical correlation case series study. Standardized outcomes and risk identification questionnaires were administered to the case population. Finally, the LMM was administered in a customary fashion to the same population.
Nineteen subjects were recruited on the basis of criteria that included symptoms of chronic recurrent low back pain. This was an employed and active, although impaired, population. Eighteen of the subjects were currently employed with limited lost work time, but chronic and recurrent pain was a common feature.
Questionnaire outcome measures were both characterologic and situation based. In addition to providing diagnoses, the physician panel was also asked to offer certain qualitative assessments, such as rehabilitative potential and functional level pertinent to activities of daily living. The impact of LMM measures on physician decision making was also assessed. Trunk angular measurements were used to assess function of patients with chronic low back disorders.
Kinematic performance on the LMM was expressed as three probability scores. These were the likelihood of abnormality, the "sincerity of effort" (exacerbation or aggravation of impairment), and the likelihood of structural anatomic disease. These variables were examined against established self-report measures of pain and disability.
The LMM and physician panels were in agreement on the presence or absence of abnormality. LMM findings tended to be more consistent with clinical history than the clinical examination. The LMM results were also generally consistent with the self-reported measures of pain and disability: a high likelihood of structural disease was associated with depression, somatization, poor health perception and diminished vitality.
The LMM appears to be a useful assessment tool for gauging the presence of LBP and LBD. It was accurate in detecting abnormality when abnormality was determined by clinical history and physician diagnosis. The LMM's differentiation of mechanical low back disease (nonanatomically specific disorders) from structurally specific low back disease was not consistent with a parallel clinical differentiation. Larger trials in a prospective format and studies on a chronically disabled population seem warranted. In an impaired but less disabled population, elevated pain and somatization did not appear to weaken the effort during testing.
下腰痛（LBP）和下腰疾病（LBDs）是一系列复杂的病症，给诊断和治疗带来了困扰。针对心理社会和情境变量的动态定量评估及问卷工具，为确定功能病理学及潜在结果提供了强有力的工具。
我们的目标是独立评估一种躯干运动测量设备——腰椎运动监测仪（LMM）的临床相关性。通过与独立医学检查及生物行为问卷进行比较，评估LMM作为临床测试的可靠性。
研究设计/场所：有三个研究部分。一个进行结构化体格检查的多专业医生小组参与了一项临床相关性病例系列研究。对病例人群发放标准化结局和风险识别问卷。最后，以常规方式对同一人群使用LMM。
根据包括慢性复发性下腰痛症状等标准招募了19名受试者。这是一个虽有损伤但仍在工作且活跃的人群。其中18名受试者目前仍在工作，误工时间有限，但慢性复发性疼痛是其共同特征。
问卷结局指标既有基于特征的，也有基于情境的。除了提供诊断外，还要求医生小组进行某些定性评估，如康复潜力以及与日常生活活动相关的功能水平。还评估了LMM测量结果对医生决策的影响。使用躯干角度测量来评估慢性下腰疾病患者的功能。
LMM上的运动学表现用三个概率分数表示。分别是异常的可能性、“努力的真实性”（损伤的加重或恶化）以及结构性解剖疾病的可能性。将这些变量与既定的疼痛和残疾自我报告测量指标进行对照研究。
LMM和医生小组在是否存在异常方面达成了一致。LMM的结果在与临床病史的一致性上往往优于临床检查。LMM的结果也通常与疼痛和残疾的自我报告测量指标一致：结构性疾病的高可能性与抑郁、躯体化、健康感知差和活力下降相关。
LMM似乎是评估下腰痛和下腰疾病存在情况的有用工具。当通过临床病史和医生诊断确定存在异常时，它能准确检测出异常。LMM对机械性下腰疾病（非解剖学特异性病症）与结构性特异性下腰疾病的区分与平行的临床区分不一致。似乎有必要进行更大规模的前瞻性试验以及针对慢性残疾人群的研究。在有损伤但残疾程度较轻的人群中，疼痛加剧和躯体化似乎并未削弱测试期间的努力程度。
