A process of subgroup identification in non-specific low back pain using a standard clinical examination and cluster analysis
Physiotherapy Research International, 05/07/2012
McCarthy CJ et al. – The identification of a group of hypervigilant non–specific low back pain (NSLBP) patients should allow the interventions to be targeted towards this group. A valid, standardized clinical examination does contribute to the diagnostic management of NSLBP.Methods
- Patients with NSLBP were examined using a standardized clinical examination.
- Each patient was examined by two physiotherapists.
- Data were analysed for item reliability and the presence of distinct subgroups using cluster analysis.
- Cross–validation of the clusters identified was conducted.
- 301 patients were examined.
- The inter–tester reliability of the majority of items was moderate to substantial (52% of items with kappa>0.40).
- A K–means cluster analysis of the two data sets revealed agreement on the presence of two subgroups.
- One group (n=47, 16%) had higher fear avoidance beliefs, anxiety and disability.
- They were more likely to be provoked by pain provocative tests.
- They were also more likely to be judged as having central sensitization and a dominant psychosocial component to their presentation.