Lumbopelvic Examination Quiz

Lumbopelvic Examination

• The lumbopelvic examination is a detailed process used by physical therapists, particularly those specializing in orthopedic physical therapy.
• The objectives of the examination focus on assessing lumbopelvic mobility, strength, and joint assessment.
• A subjective examination involves gathering patient information, including pain location, initial hypothesis, factors that worsen or improve the pain, and associated history (e.g., mechanism of injury, timeframe).
• The subjective exam also incorporates collecting information on how many times a patient experiences pain, and how much is required to reduce experience of pain.

Subjective Exam Outcome Measures

• The subjective exam collects data on pain location documented via body charts.
• The exam also covers a patient's initial hypothesis or assumptions about the cause of injury, and factors that make the pain worse and better.
• History includes the mechanism of injury, timeframe, and any relevant medical history.
• It also includes a working hypothesis, which is a preliminary idea or assumption about the potential cause of the patient's condition.

Outcome Measures

• Oswestry Disability Index (ODI)
• Patient Specific Functional Scale (PSFS)
• Fear Avoidance Beliefs Questionnaire (FABQ)
• Numeric Pain Rating Scale (NPRS)

Oswestry Disability Index (ODI)

• The ODI is a self-report questionnaire used to assess disability related to low back pain.
• It consists of 10 questions, each scored on a scale of 1 to 5, related to activities limited by back pain.
• The total score out of 50 is then multiplied by 2 to determine the percentage of disability.
• A minimum clinically important difference (MCID) of 6-10 points (or 12-20% change) is often considered clinically meaningful improvement.
• A 50% reduction in the ODI score is often considered a successful treatment outcome in research.

Patient Specific Functional Scale (PSFS)

• Patients choose 3-5 activities where they have difficulty due to pain/injury.
• The activities are rated on a scale from 0 to 10.
• A score of 0 indicates the inability to perform the activity, while a score of 10 suggests the ability to perform the activity at the same level as before the injury.
• The average of the ratings for the chosen activities provides a measure of functional limitations.
• The minimum detectable change is 2.5 points and the minimum clinically important difference is 1.5 points.

Fear Avoidance Beliefs Questionnaire (FABQ)

• The FABQ is used to assess the beliefs about activity and work that contribute to low back pain and incorporates 16 questions.
• The answers are on a scale from "completely disagree" to "completely agree".
• Higher scores indicate increased fear avoidance behavior.
• The FABQ includes two subscales—physical activity and work subscales.
• The minimum clinically important difference is 25%.

Numeric Pain Rating Scale (NPRS)

• The Numeric Pain Rating Scale (NPRS) is a simple, self-report tool used to assess pain intensity.
• Patients rate their pain on a scale of 0 to 10.
  • 0 = no pain
  • 10 = worst pain imaginable
• A minimum clinically important difference (MCID) and minimum detectable change (MDC) are both considered to be 2 points.

Physical Exam

• The primary purpose of the physical exam is to confirm or refute the working hypothesis, allowing for hypothetical deductive reasoning that leads to diagnosis/prognosis.
• The physical exam aims to reproduce the patient's familiar symptoms to determine whether they are reproducible.
• Reproducible symptoms are usually indicative of a manageable condition
• Non-reproducible symptoms may necessitate further evaluation or referral.
• The physical exam focuses on identifying impairments and functional limitations, providing specific targets for effective intervention.

Lumbopelvic Examination Subcomponents

• Lumbar ROM (Range of Motion) is evaluated for flexion, extension, lateral flexion, and rotation, with specific instructions provided on how to perform each of the motions to help with reproduction of symptoms.
• Repeated Motions: Repeating motions can assess centralization and peripheralization of symptoms.
• Dermatomes: This involves testing light touch sensation from L2 to S2, and comparing bilaterally.
  • Dermatome locations on the body are provided.
• Myotomes: This tests strength of muscles associated with various spinal levels.
  • Instructions are provided to test the different muscles, and the assessment involves determining weakness if any.
• Hip Screen: Tests hip range of motion (ROM) including flexion, internal and external rotation, and extension, along with FABER and FADIR tests to assess for reproduction of symptoms.
  • Diagrams of the hip screen are provided for visual representation.
• Joint Assessments: Passive Accessory Inter-Vertebral Joint Movement (PAIVM) and Passive Physiological Inter-Vertebral Movements (PPIVM) are evaluated to assess for limitations in movement and pain reproduction from various motions. Instructions for performing joint assessment maneuvers are provided.