Stabilization Exercise for Low Back Pain

Clinical Prediction Rule for Intervention Success

  • Age < 40
  • Straight leg raise > 91°
  • Aberrant movement present during lumbar range of motion
  • Positive prone instability test
0+
Variables Present

Positive Likelihood Ratio =

Probability of Success
67%

Clinical Prediction Rule for Intervention Failure

0+
Variables Present

Negative Likelihood Ratio =

Probability of Some Success
32%

Prone Instability Test

Diagnostic Accuracy when used alone:
Sensitivity
71%

Specificity
57%

Reference: Ferarri et al.

Evidence

Hicks GE, Fritz JM, Delitto A, McGill SM. Preliminary Development of a Clinical Prediction Rule for Determining Which Patients With Low Back Pain Will Respond to a Stabilization Exercise Program. Arch Phys Med Rehabil. 2005 Sep;86(9):1753-62.

“It appears that the response to a stabilization exercise program in patients with [low back pain] can be predicted from variables collected from the clinical examination. The prediction rules could be used to determine whether patients with [low back pain] are likely to benefit from stabilization exercises.”Hicks GE, Fritz JM, Delitto A, McGill SM.
Rabin A, Shashua A, Pizem K, Dickstein R, Dar G. A Clinical Prediction Rule to Identify Patients With Low Back Pain Who Are Likely to Experience Short-Term Success Following Lumbar Stabilization Exercises: A Randomized Controlled Validation Study. J Orthop Sports Phys Ther. 2014 Jan;44(1):6-B13.

“The previously suggested [Clinical Prediction Rule (CPR)] for identifying patients likely to benefit from [Lumbar Stabilization Exercise (LSE)] could not be validated in this study. However, due to its relatively low level of power, this study could not invalidate the CPR, either. A modified version of the CPR that contains only 2 items may possess a better predictive validity to identify those most likely to succeed with an LSE program. Because this modified version was established through post hoc testing, an additional study is recommended to prospectively test its predictive validity.”Rabin A, Shashua A, Pizem K, Dickstein R, Dar G.

Rabin A, Shashua A, Pizem K, Dar G. The Interrater Reliability of Physical Examination Tests That May Predict the Outcome or Suggest the Need for Lumbar Stabilization Exercises. J Orthop Sports Phys Ther. 2013 Feb;43(2):83-90.

“This study found a previously established CPR for predicting success with LSE to have excellent interrater reliability.”Rabin A, Shashua A, Pizem K, Dar G.

Teyhen DS, Flynn TW, Childs JD, Abraham LD. Arthrokinematics in a subgroup of patients likely to benefit from a lumbar stabilization exercise program. Phys Ther. 2007 Mar;87(3):313-25.

“These results provide construct validity for the [lumbar stabilization exercise program (LESP)] CPR and suggest that individuals with [low back pain] who are likely to succeed with an LSEP may have some combination of altered segmental structural integrity, segmental stiffness, and altered neuromuscular control during lumbar spine movement.”Teyhen DS, Flynn TW, Childs JD, Abraham LD.
No impact analysis study currently published regarding this clinical prediction rule.