title: Manual unloading of the lumbar spine: can it identify immediate responders to mechanical traction in a low back pain population? A study of reliability and criterion referenced predictive validity.
abstract: BACKGROUND
  To date, no research has examined the reliability or predictive validity of manual unloading tests of the lumbar spine to identify potential responders to lumbar mechanical traction.
  
  
  OBJECTIVE
  To determine: (1) the intra and inter-rater reliability of a manual unloading test of the lumbar spine and (2) the criterion referenced predictive validity for the manual unloading test.
  
  
  METHODS
  Ten volunteers with low back pain (LBP) underwent a manual unloading test to establish reliability. In a separate procedure, 30 consecutive patients with LBP (age 50·86±11·51) were assessed for pain in their most provocative standing position (visual analog scale (VAS) 49·53±25·52 mm). Patients were assessed with a manual unloading test in their most provocative position followed by a single application of intermittent mechanical traction. Post traction, pain in the provocative position was reassessed and utilized as the outcome criterion.
  
  
  RESULTS
  The test of unloading demonstrated substantial intra and inter-rater reliability K = 1·00, P = 0·002, K = 0·737, P = 0·001, respectively. There were statistically significant within group differences for pain response following traction for patients with a positive manual unloading test (P<0·001), while patients with a negative manual unloading test did not demonstrate a statistically significant change (P>0·05). There were significant between group differences for proportion of responders to traction based on manual unloading response (P = 0·031), and manual unloading response demonstrated a moderate to strong relationship with traction response Phi = 0·443, P = 0·015.
  
  
  CONCLUSIONS
  The manual unloading test appears to be a reliable test and has a moderate to strong correlation with pain relief that exceeds minimal clinically important difference (MCID) following traction supporting the validity of this test.
authors: Texas Woman's University, Houston, TX, USA.
authors: Brian T
authors: BT
authors: Swanson
authors: University of Connecticut Health Center, Farmington, CT, USA.
authors: Sean P
authors: SP
authors: Riley
authors: University of Connecticut Health Center, Farmington, CT, USA.
authors: Mark P
authors: MP
authors: Cote
authors: Salem State University, MA, USA.
authors: Robin R
authors: RR
authors: Leger
authors: University of Connecticut Health Center, Farmington, CT, USA.
authors: Isaac L
authors: IL
authors: Moss
authors: Andrews University, Berrien Springs, MI, USA.
authors: John
authors: J
authors: Carlos
keywords: Low back pain; Reliability; Traction; Unloading; Validity