title: Factors related to the inability of individuals with low back pain to improve with a spinal manipulation.
abstract: OBJECTIVE
  Although spinal manipulation is one of the few interventions for low back pain supported by evidence, it appears to be underutilized by physical therapists, possibly due to therapists' concerns that a patient may not benefit from the intervention. The purpose of this study was to identify factors that are associated with an inability to benefit from manipulation.
  
  
  METHODS
  Seventy-five people with nonradicular low back pain (mean age=37.6 years, SD=10.6, range=19-59; mean duration of symptoms=41.7 days, SD=54.7, range=1-252) participated.
  
  
  METHODS
  Subjects underwent a standardized examination that included history-taking; self-reports of pain, disability, and fear-avoidance beliefs; measurement of lumbar and hip range of motion; and use of various tests. All subjects received a spinal manipulation intervention for a maximum of 2 sessions. Subjects who did not show greater than 5 points of improvement on the modified Oswestry Low Back Pain Disability Questionnaire were considered to have shown no improvement with the manipulation. Baseline variables were tested for univariate relationship with the outcome of the manipulation. Variables showing a univariate relationship were entered into a logistic regression equation, and adjusted odds ratios were calculated.
  
  
  RESULTS
  Twenty subjects (28%) did not improve with manipulation. Six variables were identified as being related to inability to improve with manipulation: longer symptom duration, having symptoms in the buttock or leg, absence of lumbar hypomobility, less hip rotation range of motion, less discrepancy in left-to-right hip medial rotation range of motion, and a negative Gaenslen sign. The resulting logistic regression model explained 63% of the variance in manipulation outcome.
  
  
  CONCLUSIONS
  The majority of subjects improved with manipulation. Baseline variables could be identified that were predictive of which subjects would not improve.
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA. jfritz@pitt.edu
authors.forename: Julie M
authors.initials: JM
authors.lastname: Fritz
authors.forename: Julie M
authors.initials: JM
authors.lastname: Whitman
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Flynn
authors.forename: Robert S
authors.initials: RS
authors.lastname: Wainner
authors.forename: John D
authors.initials: JD
authors.lastname: Childs
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016015:Logistic Models; D017116:Low Back Pain / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D016059:Range of Motion, Articular; D016896:Treatment Outcome