PHYSICAL PROGRESS AND RESIDUAL IMPAIRMENT QUANTIFICATION AFTER FUNCTIONAL RESTORATION .1. LUMBAR MOBILITY

Quantification of human performance in chronic low back pain (CLBP) pa tients is essential to initiate effective treatment and guide progress in a disability-oriented functional restoration program, as well as t o objectively evaluate impairment and functional limitations at the ti me of maximum medical improvement. One such important measure of physi cal ability is range of motion. Patients who suffer from CLBP almost i nvariably have some disturbance of mobility. The major goals of the pr esent study were to: 1) develop a database of anticipated range of mot ion levels at different points in time in a representative sample of C LBP patients; 2) within the sample, determine any gender or spinal sur gery-induced differences; 3) evaluate change in range of motion produc ed by participation in a comprehensive functional restoration treatmen t program; and 4) identify residual impairment of regional range of mo tion. 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 measu res at three points in time, for sagittal/coronal motion and validity (employing the relationship between pelvic motion and supine leg raisi ng). Results demonstrated dramatic patient improvements in range of mo tion from initial referral to program completion. The most significant gains were made in pelvic motion, which returned to near normal level s, indicating that the vast majority overcame low effort or movement i nhibition produced by pain or fear of injury. Poor effort initially sh own by 28% of patients (PRE) dropped to 3% at post-study re-evaluation (FU). However, biplanar true lumbar motion generally remained mildly restricted, most significantly in the postdiscectomy group, consistent with a degree of persistent (and, possibly, permanent) impairment of mobility. There were also no significant differences in final true lum bar flexion/extension scores between male and female patients, as was previously shown for normal subjects. In summary, it appears that surg ery has more of an effect on patient response to functional restoratio n treatment than gender. These data will provide clinicians with a val uable resource for gauging expected progress in patients undergoing ef fective functional restoration treatment for disabling CLBP, and will identify expected pretreatment motion inhibition and post-treatment pe rmanent (or persistent) residual impairment of regional T12-S1 mobilit y.