Measurement of range of movement in the lumbar spine—what methods are valid? A systematic review

ObjectivesTo examine the validity of low-tech procedures used in routine clinical practice to determine the range of movement of the lumbar spine in comparison to the ‘gold’ standard of measurement.Data sourcesAMED, CINAHL, Embase, OVID Medline, The Cochrane Library, Spine and other relevant journals.Review methodsA search of electronic databases (January 2006) was complemented by hand searching reference lists of identified studies and journals, plus consultation with recognised experts to identify English language studies designed to evaluate the validity of low-tech procedures used to determine range of movement of the lumbar spine in adult human subjects presenting with non-specific low back pain.ResultsFour relevant studies were identified for analysis. Three studies investigated the use of the double-inclinometer method and one study investigated the modified-modified Schober test. The appraisal was performed using the modified QUADAS tool. The studies were considered heterogeneous and thus qualitative analysis was undertaken. This indicated limited positive evidence that the double-inclinometer method is valid for measuring total lumbar range of movement, conflicting evidence for double-inclinometer measurement of lumbar flexion range, limited evidence that the modified-modified Schober test is not valid for measurement of lumbar flexion range and limited evidence that the double-inclinometer method is not valid for measuring lumbar extension range.ConclusionThere is little evidence to support the use of current methods of range of movement measurement in the lumbar spine. If range of movement is to continue to be used during routine clinical practice to assess spinal function, degree of impairment and response to therapeutic input there is a need for scientific evidence on the validity of these procedures.