SMT 421-480

Question 1

421. What is a (+) ER test?

Answer 1

pain with extension combined with rotation towards the painful side

Question 2

422. Who obtained a concensus from expert Australian & NZ for LBP

Answer 2

Wilde et al 2007

Question 3

433. What did 94% of the panel agree on

Answer 3

localized unilateral LBP

Question 4

424. How did Delitto et al 1995 diagnose lumbar segment instability?

Answer 4

if LBP is caused by minimal perturbations

• presence of lateral shift deformity
• short term relief from manipulation
• trauma
• use of oral contraceptives
• bracing improve symptoms

Question 5

425. Paris 1985 and Maitland 1986 diagnose LSI by?

Answer 5

presence of a step off between adjacent Spinous processes

hypermobility on PPVIM and PAIVM

Question 6

426. O’Sullivan in 2000 diagnose LSI by?

Answer 6

• giving way, slipping out or locking with presence of reverse lumbopelvic rythm
• presence of posterior shear stress using posterior force

Question 7

427. What 3 authors relate LSI to aberrant motions such as an instability catch?

Answer 7

Paris 1985 ; Nachemson 1985 and Ogon et al 1997

Question 8

428. What is an aberrant motion?

Answer 8

• a sudden acceleration or deceleration of movement

and movements occuring outside the plane of motion like SB or rotation with flexion occurs from a flexed position

Question 9

429. Have aberrant motions ever been related to symptoms or abnormal movements in imaging studies?

Answer 9

No concurrent validity to date

Question 10

430. What did Barnes et al 2009 contribute to LSI studies

Answer 10

a variation from normal spine coupling

Question 11

431. Who attempted to demonstrate consistent coupling patterns?

Answer 11

Legaspi & Edmonds 2007

Question 12

432. Did Legaspi & Edmonds 2007 find a consistent coupling pattern between SB and Rot in Lx spine?

Answer 12

No.

Question 13

433. Is there evidence to support the use of coupled motion to evaluate or treat LBP?

Answer 13

No.

Question 14

434. Is coupling detectable by palpation?

Answer 14

No. The motion is only +/

Question 15

435. What 6 criteria did Paris 1985/2003 use as exam findings for LSI?

Answer 15

• Instability catch
• Hypertrophied band horizontal raised muscle tone on standing
• Step off on standing that disappears on lying
• shaking/shuddering on forward bending (Ogon et al 1997)
• Imbalance on SLR
• Grade 5 or 6 on PPIVM

Question 16

436. Kirkaldy-Wallis & Farfan 1982, O’Sullivan 2000 use what findings in their studies?

Answer 16

• painful arc during motions

- inability to stand erect s assistance from hands

Question 17

437. How did Magee 1997 diagnose LSI?

Answer 17

Prone instability test: pos test if painful c Lx compression PA at rest but no pain while actively lifting legs. NO VALIDITY.

Question 18

438. What did Friberg 1997 use?

Answer 18

Radiographs: Axial Compression c wt on shoulders, Axial Traction hanging from a bar.

Question 19

439. What did Friberg 1997 measure?

Answer 19

AP translation: accurate for detection of LSI.

Question 20

440. What did Hayes et al 1989 disprove in regards to radiographs?
441. Who else supported the lack of clinical value in films?

Answer 20

440. 42% of asymptomatic subjects have at least one segment exceeding the instability thresholds.
441. Pitkanen et al 1997

Question 21

442. What 2 categories did Hicks et al 2005 and Cook et al 2006 categorize LSI?

Answer 21

442. a. Radiographic instability (structural instability), major disruption of passive osseoligamentous constraints
     b. Clinical Instability (segmental instability, neuromuscular system symptoms inconsistent with finding on radiographic analysis

Question 22

443. According to Senntag and Maraiano 1976 what is considered excessive motion?
444. What is treatment for these patients?

Answer 22

443. Greater than 4 degrees translation or 10 degrees rotation
444. Fusion if conservative treatment have failed

Question 23

445. In regards to Algarni et al 2011 systematic review what test may be useful in ortho clinic to diagnose structural LSI?
446. How is it performed?
447. Sensitivity?
448. Specificity?
449. Positive likely hood ratio?

Answer 23

445. Passive lumbar extension test
446. Prone, PT lifts both LEs into extension to 30 cm while providing traction (+) test indicated by increased pain that disappears on return to starting position
447. 84%
448. 90%
449. 8.8

Question 24

450. Any tests for segmental instability?

Answer 24

450. No all tests have limited ability to diagnose

Question 25

451. According to Cook et al 2006 what were subjective indicators of LSI? 452. What were objective indicators of LSI?

Answer 25

451. a. "Giving way or giving out back" most related b. self-manipulator, feels the need to crack their back c. LBP epidsodes or symptoms 452. a. Poor lumbopelvic control, segmental hinging or pivoting with movement, poor proprioceptive function b. Poor coordination/neuromuscular control, juddering or shaking c. decreased strength and endurance of local muscles at level of instability

Question 26

453. What did Cook and Hegedus 2011 research?

Answer 26

453. Examined sensitivity, specificity, +LR/-LR of 14 stand alone physical tests

Question 27

454. In Cook and Hegedus 2011 what was the sensitivity cut off to rule out disorder? 455. ...to rule in disorder?

Answer 27

454. -LR less than 0.20 | 455. +LR greater/equal to 5.0

Question 28

456. In Cook and Hegedus 2011 what were tests for Thoracic spine? 457. Cervical diagnostic test? 458. Cervical screening tests? 459. Neither Screen nor diagnostic tests?

Answer 28

456. No test with adequate +LR and -LR 457. +LR only lateral glide test for C2-3 Facet Dysfunction 458. -LR only a. Prone unilateral/central PAs for facet dysfcn b. spurlings test for radiculopathy 459. a. Upper Limb Tension Test (ULTT) b. C5-6 Lateral Glide Tests

Question 29

460. In Cook and Hegedus 2011 what were tests for Lumbar diagnositcs? 461. Lumbar screening tests?

Answer 29

460. +LR a. Centralization for diagnostic b. PAIVM/PAVM diagnostic for radiologic instability c. Percussion and Supine sign for compression fracture 461. -LR a. Ext-Rot for facet pain b. SLR for nerve root

Question 30

462. What was Cook and Hegedus 2011 conclusions?

Answer 30

462. Cluster of tests provide more promising findings

Question 31

463. Who tried to use CPR to predict stabilization exercise response?

Answer 31

Hicks et al 2005

Question 32

464. Although Hicks et al 2005 has some success, was the CPR valid?

Answer 32

464. No there is not an accurately clinical way to diagnose LSI and Hicks et al 2005 used +prone instability test and + aberrant motions, these were no validated

Question 33

465. Who found fair to poor reliability of each individual aspect of Hicks et al 2005?

Answer 33

Stanton et al 2011

Question 34

466. Who found adequate inter-rater reliability of Hicks 2005? 467. But has a CPR lumbar stabilization exercise been validated? 468. Has the predictive validity of CPR for determining the need for lumbar stab exercise been determined?

Answer 34

466. Rebin et al 2013 467. No 468. No

Question 35

469. What were the results of Rubinstein et al 2011, 2012, 2013 Cochrane Review for Acute and Chronic LBP?

Answer 35

469. Acute- low to moderate quality evidence suggest no difference in effect of SMT (HVLAT or non-thrust) compared to other intervention Chronic- high quality evidence that SMT has a small statistically significant but no clinically relevent short term effect on pain relief and functional status compared to other interventions

Question 36

470. What type of evidence did Bronfort et al 2004 find regarding Acute, Chronic LBP and SMT?

Answer 36

470. Acute- moderate evidence that SMT HVLAT has better short term effect that mobilization or diathermy Chronic- moderate evidence SMT- a. SMT + strength ex equal to Rx of NSAIDs and Ex for pain relief short and long term b. SMT/Mob superior to PCP and placebo short term c. SMT/Mob superior to PT for decreased disability long term d. SMT/Mob superior to HEP decreased disability long term

Question 37

471. Who concluded for acute non-specific LBP, manipulation is better than non-steroidal anti-inflammatory drugs, diclofenac and superior to placebo?

Answer 37

471. Wolfgang et al 2013

Question 38

472. Manipulation and standard medical care better in pain reduction and disability compared to standard medical care alone?

Answer 38

472. Goertz et al 2013

Question 39

473. What did Hemmila et al 2002 find in regards to SMT pain and disability?

Answer 39

473. Pain- HVLAT greater long term pain relief than PT | Disability- HVLAT greater short and long term decrease disability than PT or HEP

Question 40

474. Who found failure rates compairing hypo/hyper moblity | 475. Who has greater failure rates for SMT?

Answer 40

474. Fritz et al 2005 | 475. hypermobile patients

Question 41

476. What was the purpose of the UK Beam Trial 2004? 477. What were the 3 method groups? 478. Was there a difference bewteen SMT and SMT + Ex at 12 months 479. Was there a difference betwen SMT and SMT + Ex for improvements in beliefs about LBP? 480. What group did not have any effectiveness at 12 months? 481. How about over general medical practice at 3 and 12 months?

Answer 41

476. Determine effectiveness of SMT 477. a. Exercise b. SMT c. SMT and Exercise 478. No Difference both gave a small but significant benefit 479. SMT +Ex a little more than just SMT 480. Exercise group 481. SMT statistically significant