Indicators of Lumbar Zygapophyseal Joint Pain: Survey of an Expert Panel With the Delphi Technique

The lumbar zygapophyseal joints (LZJs) are thought to be a source of low back pain (LBP); however, no valid or reliable indicators exist. The purpose of this study was to obtain a consensus from an expert panel on the indicators of LZJ pain. A multidisciplinary panel of 20 experts in the field of LB...

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Published inPhysical therapy Vol. 87; no. 10; pp. 1348 - 1361
Main Authors Wilde, Viktoria E, Ford, Jon J, McMeeken, Joan M
Format Journal Article
LanguageEnglish
Published United States American Physical Therapy Association 01.10.2007
Oxford University Press
Subjects
Arthralgia - complications
Arthralgia - pathology
Australia
Back pain
Backache
Causes of
Clinical medicine
Consensus
Data collection
Delphi Technique
Experts
Health Status Indicators
Heart attacks
Humans
Injections
Low Back Pain - complications
Low Back Pain - pathology
Lumbar Vertebrae
Medical research
New Zealand
Observations
Physical therapy
Polls & surveys
Psychological aspects
Psychology
Research methodology
Spinal adjustment
Studies
Zygapophyseal Joint
New Zealand
Australia
United States
Online AccessGet full text
ISSN0031-9023
1538-6724
DOI10.2522/ptj.20060329

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Abstract The lumbar zygapophyseal joints (LZJs) are thought to be a source of low back pain (LBP); however, no valid or reliable indicators exist. The purpose of this study was to obtain a consensus from an expert panel on the indicators of LZJ pain. A multidisciplinary panel of 20 experts in the field of LBP participated in this study. A 3-round Delphi survey designed to obtain a consensus on the indicators of LZJ pain was completed by use of accepted protocols. Subjects also were asked to justify their selection of each indicator. Following the 3 rounds, consensus was achieved, and 12 indicators were identified. Those that reached the highest levels of consensus were a positive response to facet joint injection, localized unilateral LBP, positive medial branch block, pain upon unilateral palpation of the LZJ or transverse process, lack of radicular features, pain eased by flexion, and pain, if referred, located above the knee. Justifications for the experts' selection of the indicators, predominantly based on pathoanatomical mechanisms, also were described. This Delphi survey identified 12 indicators of LZJ pain, each with an associated pathoanatomical mechanism justifying selection. This survey provides preliminary validation for these indicators, which will be of value in further research into the classification and treatment of LZJ pain.
AbstractList The lumbar zygapophyseal joints (LZJs) are thought to be a source of low back pain (LBP); however, no valid or reliable indicators exist. The purpose of this study was to obtain a consensus from an expert panel on the indicators of LZJ pain. A multidisciplinary panel of 20 experts in the field of LBP participated in this study. A 3-round Delphi survey designed to obtain a consensus on the indicators of LZJ pain was completed by use of accepted protocols. Subjects also were asked to justify their selection of each indicator. Following the 3 rounds, consensus was achieved, and 12 indicators were identified. Those that reached the highest levels of consensus were a positive response to facet joint injection, localized unilateral LBP, positive medial branch block, pain upon unilateral palpation of the LZJ or transverse process, lack of radicular features, pain eased by flexion, and pain, if referred, located above the knee. Justifications for the experts' selection of the indicators, predominantly based on pathoanatomical mechanisms, also were described. This Delphi survey identified 12 indicators of LZJ pain, each with an associated pathoanatomical mechanism justifying selection. This survey provides preliminary validation for these indicators, which will be of value in further research into the classification and treatment of LZJ pain.
Background and Purpose: The lumbar zygapophyseal joints (LZJs) are thought to be a source of low back pain (LBP); however, no valid or reliable indicators exist. The purpose of this study was to obtain a consensus from an expert panel on the indicators of LZJ pain. Subjects: A multidisciplinary panel of 20 experts in the field of LBP participated in this study. Methods: A 3-round Delphi survey designed to obtain a consensus on the indicators of LZJ pain was completed by use of accepted protocols. Subjects also were asked to justify their selection of each indicator. Results: Following the 3 rounds, consensus was achieved, and 12 indicators were identified. Those that reached the highest levels of consensus were a positive response to facet joint injection, localized unilateral LBP, positive medial branch block, pain upon unilateral palpation of the LZJ or transverse process, lack of radicular features, pain eased by flexion, and pain, if referred, located above the knee. Justifications for the experts selection of the indicators, predominantly based on pathoanatomical mechanisms, also were described. Discussion and Conclusion: This Delphi survey identified 12 indicators of LZJ pain, each with an associated pathoanatomical mechanism justifying selection. This survey provides preliminary validation for these indicators, which will be of value in further research into the classification and treatment of LZJ pain.
The lumbar zygapophyseal joints (LZJs) are thought to be a source of low back pain (LBP); however, no valid or reliable indicators exist. The purpose of this study was to obtain a consensus from an expert panel on the indicators of LZJ pain. A 3-round Delphi survey designed to obtain a consensus on the indicators of LZJ pain was completed by use of accepted protocols. Subjects also were asked to justify their selection of each indicator. Following the 3 rounds, consensus was achieved, and 12 indicators were identified. Those that reached the highest levels of consensus were a positive response to facet joint injection, localized unilateral LBP, positive medial branch block, pain upon unilateral palpation of the LZJ or transverse process, lack of radicular features, pain eased by flexion, and pain, if referred, located above the knee. Justifications for the experts' selection of the indicators, predominantly based on pathoanatomical mechanisms, also were described. This Delphi survey identified 12 indicators of LZJ pain, each with an associated pathoanatomical mechanism justifying selection. This survey provides preliminary validation for these indicators, which will be of value in further research into the classification and treatment of LZJ pain.
Low back pain (LBP) is a common problem that causes substantial economic, social, and psychological stresses for both the community and the individual.1,2 Effective treatment is one method of reducing the cost of LBP by accelerating recovery and minimizing recurrence. 3 Despite extensive research efforts to devise effective treatment, the extent of the LBP problem remains unchanged.2,4 Furthermore, most randomized controlled trials (RCTs) investigating the efficacy of treatment for LBP show small effect sizes at best, and conflicting results are common.5-8 A false assumption that people with LBP are a homogeneous population has been proposed as contributing to these RCT findings.9,10 The inclusion of heterogeneous samples can lead to an intervention being applied inappropriately to a proportion of subjects, resulting in either failure to respond or exacerbation of LBP.
The lumbar zygapophyseal joints (LZJs) are thought to be a source of low back pain (LBP); however, no valid or reliable indicators exist. The purpose of this study was to obtain a consensus from an expert panel on the indicators of LZJ pain.BACKGROUND AND PURPOSEThe lumbar zygapophyseal joints (LZJs) are thought to be a source of low back pain (LBP); however, no valid or reliable indicators exist. The purpose of this study was to obtain a consensus from an expert panel on the indicators of LZJ pain.A multidisciplinary panel of 20 experts in the field of LBP participated in this study.SUBJECTSA multidisciplinary panel of 20 experts in the field of LBP participated in this study.A 3-round Delphi survey designed to obtain a consensus on the indicators of LZJ pain was completed by use of accepted protocols. Subjects also were asked to justify their selection of each indicator.METHODSA 3-round Delphi survey designed to obtain a consensus on the indicators of LZJ pain was completed by use of accepted protocols. Subjects also were asked to justify their selection of each indicator.Following the 3 rounds, consensus was achieved, and 12 indicators were identified. Those that reached the highest levels of consensus were a positive response to facet joint injection, localized unilateral LBP, positive medial branch block, pain upon unilateral palpation of the LZJ or transverse process, lack of radicular features, pain eased by flexion, and pain, if referred, located above the knee. Justifications for the experts' selection of the indicators, predominantly based on pathoanatomical mechanisms, also were described.RESULTSFollowing the 3 rounds, consensus was achieved, and 12 indicators were identified. Those that reached the highest levels of consensus were a positive response to facet joint injection, localized unilateral LBP, positive medial branch block, pain upon unilateral palpation of the LZJ or transverse process, lack of radicular features, pain eased by flexion, and pain, if referred, located above the knee. Justifications for the experts' selection of the indicators, predominantly based on pathoanatomical mechanisms, also were described.This Delphi survey identified 12 indicators of LZJ pain, each with an associated pathoanatomical mechanism justifying selection. This survey provides preliminary validation for these indicators, which will be of value in further research into the classification and treatment of LZJ pain.DISCUSSION AND CONCLUSIONThis Delphi survey identified 12 indicators of LZJ pain, each with an associated pathoanatomical mechanism justifying selection. This survey provides preliminary validation for these indicators, which will be of value in further research into the classification and treatment of LZJ pain.
Audience Professional
Author Viktoria E Wilde
Jon J Ford
Joan M McMeeken
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  organization: VE Wilde, B Physio (Hons), is PhD candidate, School of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria 3010, Australia
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  organization: JM McMeeken, Dip Physio, BSc (Hons), MSc, is Foundation Professor and Foundation Head, School of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne
BackLink https://www.ncbi.nlm.nih.gov/pubmed/17684091$$D View this record in MEDLINE/PubMed
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Copyright American Physical Therapy Association Oct 2007
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Snippet The lumbar zygapophyseal joints (LZJs) are thought to be a source of low back pain (LBP); however, no valid or reliable indicators exist. The purpose of this...
Background and Purpose The lumbar zygapophyseal joints (LZJs) are thought to be a source of low back pain (LBP); however, no valid or reliable indicators...
Low back pain (LBP) is a common problem that causes substantial economic, social, and psychological stresses for both the community and the individual.1,2...
Background and Purpose: The lumbar zygapophyseal joints (LZJs) are thought to be a source of low back pain (LBP); however, no valid or reliable indicators...
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SubjectTerms Arthralgia - complications
Arthralgia - pathology
Australia
Back pain
Backache
Causes of
Clinical medicine
Consensus
Data collection
Delphi Technique
Experts
Health Status Indicators
Heart attacks
Humans
Injections
Low Back Pain - complications
Low Back Pain - pathology
Lumbar Vertebrae
Medical research
New Zealand
Observations
Physical therapy
Polls & surveys
Psychological aspects
Psychology
Research methodology
Spinal adjustment
Studies
Zygapophyseal Joint
Title Indicators of Lumbar Zygapophyseal Joint Pain: Survey of an Expert Panel With the Delphi Technique
URI http://ptjournal.apta.org/content/87/10/1348.abstract
https://www.ncbi.nlm.nih.gov/pubmed/17684091
https://www.proquest.com/docview/223113710
https://www.proquest.com/docview/20300755
https://www.proquest.com/docview/68339603
https://www.proquest.com/docview/771817645
Volume 87
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