According to the American Medical Association's Guides to the Evaluation of Permanent Impairment, 5th edition,1 range of motion (ROM) is a major element that needs to be assessed to determine the percentage of impairment.
A previous study used a questionnaire (Oswestry)3 to measure disability, compared it to a dual inclinometer to measure lumbar ROM, and found no significant relation of disability to flexion and extension. Another study by Sullivan, et al.,4 stated that flexion-active ROM and disability correlated weakly, and suggested that flexion-active ROM measures should not be used as treatment goals. Waddell, et al.,5 used a combination testing of total flexion; total extension; average lateral flexion; average straight leg raising (SLR); spinal tenderness; bilateral active SLR; and a sit-up, which met the criteria for evaluating physical impairment. But they stated that all the tests included were measures of current functional limitation, rather than of permanent anatomic or structural impairment. They stated that this raises questions about the physical basis of permanent disability, due to chronic low back pain.
Parks, et al.,2 end their article with the statement: "In their attempt to determine disability, clinicians should endeavor to emphasize the patient's ability to meet occupational demands, instead of relying solely on lumbar ROM measurements obtained during physical examination."
- Cocchiarella L, Andersson GBJ. Guides to the Evaluation of Permanent Impairment, 5th ed., AMA Press. 2000:398.
- Parks KA, Crichton KS, Goldford RJ, McGill SM. A comparison of lumbar range of motion and functional ability scores in patients with low back pain: Assessment for range of motion validity. Spine 2003;28(4):380-384.
- Grumbled M, Hurry H, Koori. Relationship between spinal mobility, physical performance tests, pain intensity, and disability assessments in chronic low back pain patients. Scand J Rehab Med 1997;29:17-24.
- Sullivan MS, Sheaf LD, Riddle DL. The relationship of lumbar flexion to disability in patients with low back pain. Phys Ther 2000;80(3):240-250.
- Waddell G, Somerville D, Henderson I, Newton M. Objective clinical evaluation of physical impairment in chronic low back pain. Spine 1992;17(6):617-628.
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