The ability of physiotherapists and physiotherapy students to evaluate and classify lumbar movement control by using lumbo-pelvic movement control tests

Abstract
Introduction Eighty five per cent of lower back pain (LBP) cases are without patho-anatomical or radiological abnormalities and are therefore diagnosed as non-specific LBP (NSLBP). Lumbo-pelvic movement control tests aid in the subgroup classification of NSLBP. This study will focus on the two most common subgroups namely the flexion and extension pattern. The aim of this study was to establish the ability of physiotherapists and physiotherapy students to evaluate and classify lumbar movement dysfunction by using six lumbo-pelvic movement control tests and three general tests. This study also intended to establish which tests physiotherapists use in the assessment of lumbo-pelvic movement control; to establish the ability of qualified physiotherapists and physiotherapy students to evaluate videos of patients with NSLBP performing six lumbo-pelvic movement control tests and three general tests and rank them as correct or incorrect; to establish the ability of qualified physiotherapists and physiotherapy students to make an overall classification as flexion pattern or extension pattern; and to compare the ability of evaluation and classification in relation to level of experience of qualified physiotherapists and physiotherapy students. Methodology This study was conducted as a quantitative, observational study. An expert panel gave input, helped to develop a questionnaire and chose the videos used. Individuals with NSLBP were recruited from two private out-patient physiotherapy practices in Johannesburg for the video recording. Qualified physiotherapists attending courses, meetings, staff training and other physiotherapy gatherings around Gauteng were invited to participate, and the physiotherapy students were approached through the physiotherapy departments at three universities in Gauteng. The qualified physiotherapists completed the first part of the self-administered questionnaire prior to a short information session. Thereafter the rest of the questionnaire was completed by the participants (qualified physiotherapists and physiotherapy students) while they observed videos of individuals with NSLBP with flexion or extension patterns. Data was entered into a Microsoft-Excel spread sheet for data cleaning and coding purposes. Therafter the STATA Data Analysis and Statistical Software (release 12; Texas, USA) program was used for data analysis. Means, standard deviations, percentages and the Fisher‟s exact test was used. Results A sample of 93 qualified physiotherapists and 96 fourth year physiotherapy students participated in the study. Eighty six percent (n=92) of the qualified physiotherapist participants were familiar with lumbo-pelvic movement control tests but many are not using them clinically to assess patients with NSLBP (13% use waiters bow, 17% use rocking forwards, 18% use rocking backwards, 34% use sitting knee extension, 37% use prone knee flexion and 75% use posterior pelvic tilt). There were very few statistically significant differences between the observations made for the individual tests by the qualified physiotherapists and the physiotherapy students (p-value≤0.05). A statistically significant difference was found in only three out of 24 videos for both the qualified physiotherapists and physiotherapy students (p=0.001, p= 0.007 and p=0.033) respectively. For the overall classification of flexion or extension patterns the physiotherapy students‟ odds of getting the assessment wrong were only 0.57 in relation to the qualified physiotherapists (p=0.078, 95% confidence interval). Physiotherapists with further qualifications and more experience did not perform better than the inexperienced physiotherapists with regard to the overall classification of a flexion or extension pattern. Conclusion Even though the majority of qualified physiotherapists are familiar with lumbo-pelvic movement control tests only a few are using the lumbo-pelvic movement control tests clinically. There was not a big difference between the classification results given by the qualified physiotherapists and those offered by the physiotherapy students. Physiotherapists (novice and experienced) and physiotherapy students are able to classify patients with NSLBP into a flexion or extension pattern after receiving minimal training.
Description
A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in fulfillment of the requirements for the degree of Master of Science in Physiotherapy. Johannesburg 2016
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