Lumbar Stabilization CPR | Clinical Predication Rule by Hicks

One of the biggest problems in the treatment of chronic low back pain is that low back pain patients are very heterogeneous. This means that there is no single magic pill treatment for every chronic low back pain patient, and it is, therefore, helpful to further categorize these patients.

One such classification is described by the clinical prediction rule of Hicks et al. (2005). This clinical prediction rule is designed to determine if your patient is likely to benefit from a stabilization exercise program.

Three or more out of the following four signs or tests increase the odds for success with a stabilization exercise program by a factor of 4.0:

1. Age below 40 years.
2. Straight leg raise > 90°
3. The presence of aberrant motions during lumbar AROM
4. A positive prone instability test.

At the same time, if you want to rule out a stabilization exercise program for your patient, you can apply the following rule if two or more of the following four items arepresent. The odds for success with a stabilization exercise program decreases by a factor of 0.18:

1. A fear avoidance belief questionnaire (FABQ), and actually, the activity (FABQ-A) subscale thereof of eight or smaller. So if patients were less fearful to carry out activities, they actually had a worse chance of success with a stabilization program.
2. Absence of aberrant movement during lumbar ROM
3. A negative prone instability test
4. No hypomobility during the lumbar spring test

In the study, the exercise program consisted of different exercises for the transverse abdominals, the multifidus, the quadratus lumborum, as well as the oblique abdominals.

If you are curious about another clinical prediction rule in the spine, check out the following post:

• CPR for the success of lumbar manipulation

Hicks, G. E., Fritz, J. M., Delitto, A., & McGill, S. M. (2005). Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Archives of physical medicine and rehabilitation, 86(9), 1753-1762.