The centralization phenomenon and stability in patients with low back pain.

For clinicians, positive clinical tests for identification of lumbar spine instability are indicators for the use of stabilization exercises. However, in our clinical experience these tests frequently become negative after the patient has demonstrated a centralization response assessed with Mechanical Diagnosis & Therapy (MDT). Given that this response is commonly elicited during MDT assessment, it may be that instability tests should be preceded by a MDT assessment to ensure appropriate interpretation. The aim of this study will be to assess the influence of the centralization response on the outcome of instability tests in patients with low back pain.

Design: Observational study

Methods:
Patients will be recruited from a private physical therapy clinic. Each patient will be assessed by two examiners on the same day. The first examiner will conduct a standardized set of tests to identify signs of lumbar spine instability before and directly after a MDT session which is conducted by the second examiner. This second examiner will classify each patient as a centralizer or non-centralizer. The assessments of instability tests and the MDT assessment will be conducted independently and the examiners will be blinded to each other’s results. At least 100 patients will be included. The differences between pre-test and post-test results on the instability test will be described in percentages and via X2 tests for the two groups (centralizers and non-centralizers). Analyses will be performed to investigate whether selected baseline characteristics have an influence on the outcomes.
The present study will contribute to our knowledge about the influence of MDT, and more specifically the centralization response, on clinical lumbar spine stabilization measures in patients with low back pain.

For clinicians, positive clinical tests for identification of lumbar spine instability are indicators for the use of stabilization exercises. However, it is our clinical experience that these tests frequently become negative after the patient has demonstrated a centralization response assessed with Mechanical Diagnosis & Therapy (MDT). Given that this response is commonly elicited during MDT assessment, it may be that instability tests should be preceded by a MDT assessment to ensure appropriate interpretation. The aim of this study will be to assess the influence of the centralization response on the outcome of instability tests in patients with low back pain. We hypothesize that the number of positive tests will reduce in patients whose pain centralizes, but that this will not be the case for patients who do not centralize.

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Patients will be recruited from a private physical therapy clinic. Each patient will be assessed by two examiners on the same day. The first examiner will conduct a standardized set of tests to identify signs of lumbar spine instability before and directly after a MDT session which is conducted by the second examiner. This second examiner will classify each patient as a centralizer or non-centralizer. The assessments of instability tests and the MDT assessment will be conducted independently and the examiners will be blinded to each other’s results. At least 100 patients will be included.