Yarznbowicz Richard, Tao Minjing
Center for Orthopedic and Sports Physical Therapy, Tallahassee, FL, USA.
Department of Statistics, Florida State University, Tallahassee, FL, USA.
J Man Manip Ther. 2018 Dec;26(5):281-291. doi: 10.1080/10669817.2018.1505329. Epub 2018 Aug 6.
A detailed description of how Directional Preference (DP) constructs are measured could accelerate research to practice translation and improve research findings for Mechanical Diagnosis and Therapy (MDT) stakeholders. A secondary analysis of a prospective, observational cohort study was conducted to understand (1) the type and prevalence of DP constructs at first examination and (2) the relationships between DP constructs and clinical outcomes at follow-up. Data were collected and analyzed from 1485 consecutive patients who presented to outpatient, private practice clinics with primary complaints of non-specific low back pain (LBP); 400 patients met the inclusion criteria and completed first examination and follow-up data. Statistical analysis determined prevalence and the relationships between DP constructs at first examination and clinical outcomes at follow-up. The primary findings in this investigation were that (1) the most prevalent DP constructs at first examination were related to range of motion (ROM) and pain intensity (Patient Reported Improvement in ROM (74.8%), Increase in Spine ROM (29.5%), and Pain Intensity Change (17.3%)), (2) all groups improved and made clinically meaningful improvements in disability and pain intensity at follow-up, (3) no clinically significant differences in disability or pain intensity were found between the groups at follow-up, and (4) 26.5% and 6.5% of patients exhibited a relative increase in lumbar spine extension and flexion ROM, respectively, post repeated movement testing on the first examination. The findings in this study assist providers in making assessment and treatment decisions with their patients by offering insight regarding the most prevalent DP constructs typically found at the first examination and their subsequent association with outcome when Centralization (CEN) does not occur. Recommendations for researchers have been made to further explore the DP framework used in this study.
对方向偏好（DP）结构测量方法的详细描述可以加速研究成果向实践的转化，并改善机械诊断与治疗（MDT）利益相关者的研究结果。我们对一项前瞻性观察队列研究进行了二次分析，以了解：（1）首次检查时DP结构的类型和患病率；（2）随访时DP结构与临床结果之间的关系。我们收集并分析了1485例因非特异性腰痛（LBP）为主诉前来门诊私人诊所就诊的连续患者的数据；400例患者符合纳入标准并完成了首次检查和随访数据。统计分析确定了首次检查时DP结构的患病率及其与随访时临床结果之间的关系。本研究的主要发现为：（1）首次检查时最常见的DP结构与运动范围（ROM）和疼痛强度有关（患者报告的ROM改善（74.8%）、脊柱ROM增加（29.5%）和疼痛强度变化（17.3%））；（2）所有组在随访时功能障碍和疼痛强度均有所改善且具有临床意义；（3）随访时各组在功能障碍或疼痛强度方面未发现临床显著差异；（4）在首次检查时进行重复运动测试后，分别有26.5%和6.5%的患者腰椎伸展和屈曲ROM出现相对增加。本研究结果有助于医疗服务提供者与患者做出评估和治疗决策，提供有关首次检查时通常发现的最常见DP结构及其在未发生中心化（CEN）时与结果的后续关联的见解。已向研究人员提出建议，以进一步探索本研究中使用的DP框架。
