Comparison of Tests for Lumbar Flexion and Hip Function in Patients With and Without Axial Spondyloarthritis

Abstract

Objective. To compare the 15-cm Schober test with the 10-cm Schober test and the intermalleolar distance (IMD) with the internal hip rotation (IHR). Methods.A cross-sectional study was conducted among both healthy individuals and patients with axial spondyloarthritis (SpA).The spinal and hip mobility tests were assessed in all subjects. Agreement between the different tests was assessed with correlation coefficients, Bland and Altman agreement, and by cumulative probability plots. The component scores for lumbar flexion in the Bath Ankylosing Spondylitis Metrology Index (BASMI) with use of either the 10-cm Schober test or the 15-cm Schober test were compared. Results. A total of 393 healthy individuals (51% males; mean age 44 years) and 90 patients with axial SpA (53% males; mean age 49 years) were included. A strong correlation was found between the 10-cm and 15-cm Schober test, in both healthy individuals (r ‫؍‬ 0.89) and in patients (r ‫؍‬ 0.93). The 10-cm Schober test was systematically lower than the 15-cm test with a mean ؎ SD difference of 1.5 ؎ 0.8 cm in patients, resulting in a higher total mean ؎ SD BASMI score of 0.4 ؎ 0.2 points. The correlation between IMD and IRH was weak, both in healthy individuals (r ‫؍‬ 0.29) and in patients (r ‫؍‬ 0.40). Conclusion. The 10-cm and 15-cm Schober tests are highly correlated but, as expected, the 10-cm method is systematically lower than the 15-cm method. Therefore, these measures cannot be interchangeably used in the BASMI. The IMD and IHR are not correlated, indicating that they measure different aspects of hip mobility. Therefore, the IHR cannot be used as a substitute for the IMD.

Schober test is not a valid assessment tool for lumbar mobility

“…The Schober test is a widely used clinical tool for assessment of lumbar mobility both in LBP patients as well as in patients with axial spondylarthritis or other rheumatologic diseases 13 – 17 . The aim of our study was to assess, whether the Schober test and its cut-off at 5 cm correlate with Lumbar RoF measured by non-invasive devices such as Epionics SPINE ® and Idiag M360 ® .…”

“…For lumbar mobility the Schober test 11 , 12 is considered to be an efficient diagnostic tool. Historically, the Schober test has proven to be a reliable measure in the quantification of lumbar flexibility and is used in the diagnosis of LBP as well as in rheumatological diagnostics to quantify loss of motion in axial spondylarthritis 13 – 17 . While the patient is in a standing position, the examiner marks the spinous process of the first sacral vertebra and 10 cm above this point.…”

Ankylosing Spondylitis Patients Have Lower Risk of Dislocation Following Total Hip Arthroplasty Compared with Patients Undergoing Lumbar Spinal Fusion Surgery

“…[30][31][32] The decreased lumbar ROM and increased spinopelvic stiffness in AS patients could be attributed to severer spinal ankylosis and sagittal imbalance, which was known to be associated with the decreased hip ROM. 30,[33][34][35] Therefore, compared with LSF patients, AS patients suffered from severer stiffness and lower mobility along the spine-pelvis-hip axis. The lower mobility restricted movement along the spine-pelvis-hip axis and reduced the possibility of risky movement which could result in dislocation events.…”

Índice de masa corporal y flexibilidad lumbar en habitantes de una cooperativa de vivienda, Lima

“…Luego el paciente realiza una flexión anterior, y la distancia entre las dos marcas aumenta a 15 cm, mientras que en flexión posterior se acorta hasta 8-9 cm, el cual esta utilizado en la realidad peruana con pacientes similares a la presente. Los parámetros para el test de Schober, los resultados se interpretan de la siguiente manera: para la flexión lumbar: bueno = +5cm; regular = +3cm; deficiente = 0 y para la extensión lumbar: bueno= +3cm; regular=+1cm; deficiente = 0cm (11,12).…”