Findings from previous reliability studies of the lumbar ROM measures suggest that palpation inaccuracies were the main source of error. While a number of factors including rater skill, equipment limitations, patient selection and pain status may affect reliability of results, certainly landmarking is one of the major issues that affects the reliability and validity of joint motion measurements. Ideally tools and the associated procedures to use them are reliable, valid, cost-effective & easy-to-use. When making routine clinical decisions, a variety of measurement characteristics are important to consider. When making judgments on a patient’s level of impairment, particularly when his/her future financial compensations hang in the balance, reliable methods are essential for determining impairment in spinal motion. In the 6th edition however, ROM was removed from the list because of variability in results and lack of strong evidence supporting the validity and reliability of the ROM measures that are currently used. It recommended the use of multiple measures including the CDI and the MMS. Īccording to guidelines set out by the American Medical Association (AMA) in its 4th and 5th edition, compensation entitlements for patients with low back pain were based in part, on the impairment of back movement. Nonetheless, dual inclinometry is considered to be more valid tool than modified-modified Schobers (MMS) because the measurement results are expressed in degrees, which correlate with the angular motion of lumbar flexion and extension. The poor results were mostly attributed to differences between the raters, reflected by the accuracy and consistency of manual palpation of bony landmarks, and the handling of the inclinometer heads along the subject’s spine. The authors of that review concluded that there was little evidence to support current measures of lumbar ROM. In a systematic review on the validity of instruments used to measure lumbar ROM, three out of the four studies included were on dual inclinometry. showed dual inclinometry had acceptable intra-rater reliability results (flexion ICC = 0.90, extension ICC = 0.71), but fair to poor inter-rater values (flexion ICC = 0.67, extension ICC = 0.35). Previous studies have addressed the validity and reliability of the CDI. One of the methods that has been used to measure joint mobility in research and clinical practice is computerized dual inclinometry (CDI). Furthermore, range of motion measurements often reflect physical impairment or functional mobility in which case external measures of the ROM are more directly applicable. However, performing a radiograph on every patient with LBP is costly and time-consuming in a clinical setting. Radiographs are considered the gold standard for measuring absolute joint motion. At present, there is no conclusive evidence to advocate one method over another. Tools available for clinical use include: plumb line, goniometry, fingertip to floor, flexicurve, tape measures, visual-photographs, and dual inclinometry. Ī great deal of research has gone into examining different tools for measuring spinal mobility. Range of motion (ROM) amongst other variables has been identified to be an indicator of impairment due to back pain. The high costs of low back pain are borne by the government, insurance companies, and the general public in the form of medical treatments and impairment compensations. Low back pain (LBP) is one of the most common musculoskeletal problems across the globe with an estimated lifetime incidence of 60-80 %.
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