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Assessing Musculoskeletal Performance of the Back Extensors Following a Single-Level Microdiscectomy

Background. Lumbar extensor endurance is a better predictor of first-time incidence of LBP than strength (Biering-Sorensen, 1984)Sorensen Test (ST)Good reliabilityAppropriate for all patients?. Purpose. Appropriateness of ST test for s/p single-level microdiscectomy patientsIdentify characteristics of patients inappropriate for ST testDescribe modified ST procedure.

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Assessing Musculoskeletal Performance of the Back Extensors Following a Single-Level Microdiscectomy

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    1. Assessing Musculoskeletal Performance of the Back Extensors Following a Single-Level Microdiscectomy Alyssa Keeney-Roe, SPT Alan Tang, SPT

    3. Purpose Appropriateness of ST test for s/p single-level microdiscectomy patients Identify characteristics of patients inappropriate for ST test Describe modified ST procedure

    4. Subjects n=68(39 men, 29 women) Thorough exclusion criteria (e.g. previous back surgeries, nervous system disorders, PVD, etc.) Inclusion criteria s/p single-level microdiscectomy Predominant leg sx’s, radicular pain, restricted SLR, positive LLNT (+)MRI for disc protrusion

    5. Methods Evaluator Physical Therapists Intake 4-6 weeks post-op Pt history Objective exam Questionnaires (OSW, RM, FABQ, FABQ-W, FABQ-A, SQOL, PAS) Functional tests (STS, WALK50, WALK5, SIT10) each followed by VAS Modified ST Study notes improvement prob. Due to learning affect. Not interested in showing change just if test can be used in this/all populations Study notes improvement prob. Due to learning affect. Not interested in showing change just if test can be used in this/all populations

    6. Methods Intervention Physical Therapists Retest 3-7 days after original test 1st 28 patients Why so many intervention PTs? (16)

    7. How long pt can hold trunk horizontal over edge of table Original Sorensen Test Remember to tell everyone that these are tests for lumbar extensor endurance. Detailed protocol established based on exercise principles, many levels and therefore might become fatiguedRemember to tell everyone that these are tests for lumbar extensor endurance. Detailed protocol established based on exercise principles, many levels and therefore might become fatigued

    8. Modified Sorensen Test 6 levels of varied angles RPE taken at end of each level End criteria for each level: 20 second hold in neutral L/S position Adverse symptoms (increased pain) Participant felt they could no longer continue Tester ended test in best interest of participant Completion of test: Reached level 6, RPE of 5, unwilling to go on or met one criteria to stop test

    9. Statistics Categories created: Completed test at Level 6 (C) Noncompleters (NC) Compared to determine characteristics of two groups (Independent t test and chi squared) Profile of groups (stepwise logistic regression analysis) a<.05 Used correct stats for type of dataUsed correct stats for type of data

    10. Results Reliability: 17.6% All participants able to complete Level 1 FABQ-W and PAS significant predictors (p<.05) at 78.8%+ STS (p<.10) at 84.8% of NC 51.5% did not reach Level 6/original ST Level 1-4: Main reason stopped was pain Level 5: Main reason RPE Performance also correlated with physical activity level and fear-avoidance Fear avoidance beliefs questionnaire- work subscale,(how PA and work affects LBP),Fritz et al showed useful to look for those at risk for long term disability and long term absence at work, PAS Aadahl and Jorgensen estimate 24 hour physical activity questionnaire (mets)-Only used on asymptomatic subjects before, Repeated sit to stand: 5 sequences (seconds)Fear avoidance beliefs questionnaire- work subscale,(how PA and work affects LBP),Fritz et al showed useful to look for those at risk for long term disability and long term absence at work, PAS Aadahl and Jorgensen estimate 24 hour physical activity questionnaire (mets)-Only used on asymptomatic subjects before, Repeated sit to stand: 5 sequences (seconds)

    11. Discussion Reliability: Low, maybe because of many testers Findings: Less active and more fearful unable to complete test Modified test more universal Detailed discussion looking at results and extrapolating meaning Good at looking at own weaknessesDetailed discussion looking at results and extrapolating meaning Good at looking at own weaknesses

    12. Conclusion Clinical Relevance: Pain should not dictate testing. Pts’ perception of pain related to FABQ-W should. Original too intense for this population Future research: How results from Modified ST can be used to prescribe rehab exercises

    13. Relevance to Muscle Decreased endurance 4-6 weeks decreased activity Possible change slow vs. fast fibers Injury to muscle Constant aggs before surgery, Incision sites Decreased ability to repair/atrophy/fewer sarcomeres in parallel/series Decreased motor unit recruitment Clinical Relevance Modified ST more useful than Original ST in patients with pain and prolonged disuse

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