Kann zentralisierender Schmerz bei der Erstuntersuchung den Behandlungserfolg bei Erwachsenen mit LWS-Beschwerden vorhersagen?

Zusammenfassung

Bisher ließ sich vom in mehreren aufeinanderfolgenden Untersuchungen bestimmten Zentralisationsphänomen eine gute Prognose ableiten, wohingegen eine Nichtzentralisation chronische Kreuzschmerzen und Behinderung vorhersagte.

Diese Studie ging der Frage nach, ob bei der Erstuntersuchung festgestellte zentralisierende Rückenschmerzen in der LWS (LBP) ein besseres Behandlungsresultat vorhersagen als nicht zentralisierende LBP. Dazu wurden die 134 erwachsenen Studienteilnehmer in 3 Behandlungsgruppen eingeteilt: orthopädische Manuelle Therapie, McKenzie-Methode und Ratschläge, aktiv zu bleiben.

Insgesamt zeigten bei der Erstuntersuchung festgestellte zentralisierende LBP tendenziell bessere und langfristigere Vorhersagen.

Abstract

A number of consecutive studies have shown that certain centralisation phenomena indicate a good prognosis whereas non-centralisation predicts chronicification of low back pain and disability.

This study examined whether centralising low back pain (LBP) defined at the initial assessment and treatment session might predict better treatment outcomes than non-centralising LBP. For this purpose the 134 adult study participants were allocated to 3 treatment groups: orthopaedic manual therapy, McKenzie method and advice to stay active. In general centralising LBP defined on the initial visit tended to predict better and longer lasting prognosis.

Zentralisationsphänomen - Nicht-Zentralisationsphänomen - Behinderung - Rückenschmerzen

centralisation phenomenon - non-centralisation phenomenon - disability - low back pain

Literatur

• 1 Aina A, May S, Clare H. The centralization phenomenon of spinal symptoms a systematic review.  Man Ther. 2004;  9 134-143
• 2 Airaksinen O, Brox J I, Cedraschi C et al. European guidelines for the management of chronic non-specific low back pain.  Eur Spine J. 2006;  S2 192-300
• 3 Bybee R, Hipple L, McConnell R et al. The relationship between reported pain during movement and centralization of symptoms in low back pain patients.  manuelletherapie. 2005;  9 122-127
• 4 Donelson R, Silva G, Murphy K. Centralization phenomenon. Its usefulness in evaluating and treating referred pain.  Spine. 1990;  15 211-213
• 5 Fritz J M, Delitto A, Vignovic M et al. Interrater reliability of judgements of the centralization phenomenon and status change during movement testing in patients with low back pain.  Arch Phys Med Rehab. 2000;  81 57-61
• 6 Hefford C. McKenzie classification of mechanical spinal pain: profile of syndromes and directions of preference.  Man Ther. 2008;  13 75-81
• 7 Hicks C M (ed).. Research methods for clinical therapists. Applied project design and analysis. Churchill Livingstone/Harcourt. New York; 2000 3 rd ed
• 8 Jacobsen B S. Organizing and displaying data. In Munro Hazard B, (ed) Statistical methods for health care research.. 3 rd ed. Philadelphia: Lippincott-Raven; 1997
• 9 Jordan K, Dunn K M, Lewis M et al. A minimal clinically important difference was derived for the Roland-Morris disability questionnaire for low back pain.  J Clin Epidemiol. 2006;  59 45-52
• 10 Kilpikoski S, Airaksinen O, Kankaanpää M et al. Interexaminer reliability of low back pain assessment using the McKenzie method.  Spine. 2002;  27 E207-E214
• 11 Kilpikoski S, Alen M, Paatelma M et al. Outcome comparison among working adults with centralizing low back pain. Secondary analysis of a randomized controlled trial with 1-year follow-up.  Advances in Physiotherapy. 2009;  DOI: 10.1080 / 14 038 190 902963 087
• 12 Long A L. The centralization phenomenon. Its usefulness as a predictor of outcome in conservative treatment of chronic low back pain (a pilot study).  Spine. 1995;  20 2513-2521
• 13 Long A, Donelson R, Fung T. Does it matter which exercise? A randomized controlled trial of exercise for low back pain.  Spine. 2004;  29 2593-2602
• 14 McKenzie R A, May S. The lumbar spine mechanical diagnosis and therapy. (eds). Spinal Publication. Waikanae; 2003
• 15 Ostelo R W, Vet H C. Clinically important outcomes in low back pain.  Best Pract Res Clin Rheumatol. 2005;  19 593-607
• 16 Paatelma de M, Kilpikoski S, Simonen R et al. Orthopaedic manual therapy, McKenzie method or advice only for low back pain in working adults: A randomized controlled trial with one year follow-up.  J Rehabil Med. 2008;  40 858-863
• 17 Ratzmjou H, Kramer J F, Yamada R. Inter-tester reliability of the McKenzie evaluation in mechanical low back pain.  JOSPT. 2000;  30 368-383
• 18 Roland M, Fairbank J. The Roland-Morris Disability Questionnaire and the Ostwestry Disability Questionnaire.  Spine. 2000;  25 3115-3124
• 19 Scott J, Huskisson E. Vertical and horizontal visual analogue scales.  Ann Rheum Dis. 1978;  38 560-565
• 20 Skytte L, May S, Petersen P. Centralization: Its prognostic value in patients with referred symptoms and sciatica.  Spine. 2005;  30 E293-E299
• 21 Van Tulder M, Becker A, Bekkering T et al. European guidelines for the management of acute non-specific low back pain in primary care.  Eur Spine J. 2006;  S2 169-191
• 22 Werneke M, Hart D L. Centralization phenomenon as a prognostic factor for chronic low back pain and disability.  Spine. 2001;  26 758-765
• 23 Werneke M, Hart D L. Discriminant validity and relative precision of classifying patient with non-specific neck and back pain by anatomic pain patterns.  Spine. 2003;  28 161-166
• 24 Werneke M, Hart D L, Resnik L et al. Centralization: prevalence and effect on treatment outcomes using a standardized operational definition and measurement method.  JOSPT. 2008;  38 116-125