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On "A New Evaluation Method for Lumbar Spinal Instability..." Kasai et al. Phys Ther. 2006;86:1661–1667.

Typically, studies of this type include a table of subject demographics, such as height, weight, body mass index, and so on. This information allows readers to determine the applicability of a test to their own patient population. The publication of this information would be helpful.

The concept of lumbar instability remains controversial, with widely varying levels of definition and clinical relevance in the medical literature. In fact, Groopman² argued that "spinal instability" is a term used to justify an operation. Kasai and colleagues¹ attempted to define instability based on the widest of 3 proposed radiographic standards reported in the literature. It is unclear whether these radiographic measures reflect clinical signs and symptoms of lumbar instability, or what use they have in patient management.

Despite this fact, the investigators concluded that "...the data from the PLE [passive lumbar extension] test for subjects with lumbar degenerative diseases can be very useful for determining treatment strategy, that is, whether to provide conservative treatment with a corset or to perform procedures such as spinal fusion.¹ A "corset" is more suggestive of a Civil Warera undergarment than a 21st century musculoskeletal management strategy. Because this article was published in our professional journal, we were struck by the absence of any reference to current best evidence on the management of lumbar instability,³ which includes physical therapy intervention as an appropriate management strategy. We are excited about the new changes in PTJ, and, in keeping with the quality of the Journal and what it represents to our profession, we would welcome the addition of this information in an author response.

Kevin Baker, Jason Rodeghero, Hanni Cowley and Albert Bone

K Baker, PT, MSR, FAAOMPT, rbaker{at}memorialsb.org
J Rodeghero, PT, DPT, OCS, MTC, ATC

References

1. Kasai Y, Morishita K, Kawakita E, et al. A new evaluation method for lumbar spinal instability: passive lumbar extension test. Phys Ther 2006;86:1661–1667.[Abstract/Free Full Text]
2. Groopman J. A knife in the back: is surgery the best approach to chronic back pain? New Yorker. April 8, 2002.
3. O'Sullivan PB, Phyty GD, Twomey LT, Allison GT. Evaluation of specific stabilizing exercises in the treatment of chronic low back pain with radiologic spondylolysis or spondylolisthesis. Spine. 1997;22:2959–2967.[CrossRef][ISI][Medline]

This Article Full Text (PDF) Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Baker, K. Articles by Bone, A. Search for Related Content PubMed PubMed Citation Articles by Baker, K. Articles by Bone, A.