A process of subgroup identification in non-specific low back pain using a standard clinical examination and cluster analysis
Physiotherapy Research International, 05/07/2012McCarthy 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.
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.
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