The development and testing of an atlas of standardized low back tests and measures by NIOSH was discussed. An initial group of 105 tests and measures was identified by a panel of clinicians, researchers, and educators as representing the totality of tests and measures used during clinical evaluation of a low back injury. A peer review panel then recommended initial criteria for description of each test/measure. These included a clearly worded description of the procedure and accurate measurement devices, standardization of independent variables, objective biomechanical standards for measurement of outcomes, and anthropometric descriptions that followed commonly accepted published material. These criteria were met by 85 tests/measures, which were then subjected to a five site study focusing on the five clinical areas, subjective (history), neurologic, kinesiologic, muscle strength/length, and movement testing. More than 250 patients and 15 examiners were included in this phase of the study. Data analysis produced more than 12,000 individual analyses, from which each test/measure was classified as acceptable, marginal, low, or insufficient distribution. There were 68 tests and measures classified as acceptable or marginal based on the five site study, and these were subjected to restructuring and standardization and then to a clinical study including 53 subjects with low back injury. This phase produced a set of 19 tests and measures considered to be acceptable or marginal. These tests/measures were tabulated by name, description, and starting position. The authors conclude that the methodology used in developing this atlas may serve as a pattern for developing similar systems for upper and lower extremity musculoskeletal injury assessment.
National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA