Center for Smart Use of Technologies to Assess Real World Outcomes (C-STAR)
May 9–10
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The Biering-Sørensen test is a timed measure used to assess the endurance of the trunk extensor muscles. It is used to assist in the prediction of the incidence and occurrence of low back pain in patients.
1
10 minutes
Less than 10 minutes for setup, explanation, demonstration, and test performance
Child
6 - 12
yearsAdolescent
13 - 17
yearsAdult
18 - 64
yearsElderly Adult
65 +
yearsCaitlin Clark, SPT; Kristen Crenshaw, SPT; Whitney Gore, SPT; Ryan Herr, SPT; Thomas Joyce, SPT; Brett Koermer, SPT; Ryan Koter, SPT; Ashley Maxwell, SPT; Megan McCallum, SPT; Melissa Mosley, SPT; Maredith Russo, SPT; Erin Wyant, SPT.
It is important to consider a patient’s prior history and the severity of their chronic low back pain before administering the test. The test puts an equivalent of 4,000N load on the back. Although there is no reported evidence of worsened pain due to completion of the test, it is something to consider. Patient’s gender may also impact test performance. Subjective consideration of patient’s current level of pain and motivation may be applicable as well. “The [physical] activity level of subjects does not appear to affect the reliability of the Biering-Sorensen test results” (Latimer et al, 1999). “The main reason for termination in the group with current NSLBP was feelings of fatigue rather than an exacerbation of the original LBP, whereas in the group asymptomatic for NSLBP the main reason for termination was development of pain in the buttocks, posterior thighs, and low back” (Latimer et al, 1999). Luoto’s study used a modified version of the static back endurance test of the Biering-Sorensen test. It is important to recognize the potential effect that psychological disturbance can have on an individual’s performance on the endurance test. Muscular endurance can be affected by factors such as competitiveness, pain tolerance, and boredom. Psychological disturbance assessed by way of questionnaires has been found to correlate significantly with underperformance on the endurance test (Mannion et al. 2001).
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Current, Previous, and No History of Lower Back Pain (Latimer et al., 1999)
Young, Healthy Subjects (McGill et al., 1999)
Pain Free and Nonspecific Lower Back Pain (Simmonds et, al., 1998)
Current, Previous, and No History of Lower Back Pain (Latimer et al., 1999; Calculated from the SEMs given in the article)
Young, Healthy Subjects (McGill et al., 1999; Calculated from the SEMs given in the article)
Males: MDC= 20.0s
Females: MDC=23.5s
Pain Free and Nonspecific Lower Back Pain (Simmonds et, al., 1998;Calculated from the SEMs given in the article)
Lower back Pain: MDC= 24.1
Healthy: MDC= 48.8
Healthy Populations (Demoulin et al., 2006)
Biering-Sørensen n>900:
Males:
Healthy: 198s
Prior LBP: 176s
Current LBP: 163s
Females:
Healthy: 197s
Prior LBP: 210s
Current LBP: 177s
Holmstrom et al. n=203
Males:
Healthy: 171.5s
Prior LBP: 166.7s
Current LBP: 137.5
Mannion & Dolan, n= 229:
Males: 116s, Females: 142s
Hultman et al. n=148
Males
Healthy: 150s
Prior LBP: 136s
Current LBP: 85s
Mannion et al. n = 200
Healthy Females: 141.7s
Prior LBP: 123s
Alaranta et. al. n = 475; Males and Females
No LBP: 100s
Prior LBP: 85s
Current LBP: 85-99s
Latimer et al. n= 63; Males and Females:
No LBP: 132.6s
Prior LBP: 107.7s
Current LBP: 94.6s
Simmonds et al. n= 92; Males and Females
No LBP: 77.8s
Current LBP: 39.5s
Luoto et al.,
n=43: Males 104-240s and Females 110-240s
Keller et al, 2001
CLBP: 98 (45-128); 93 (64-136)
Healthy: 146 (111-188); 130 (105-186)
Latimer et al., 1999
n=63; Current LBP 94.6s, Previous LBP 107.7s, Asymptomatic LBP 132.6s (average for 2 holding times since they performed the test twice).
n=63; Active=117.9s, Inactive=107.9s
Simmonds et al., 1998
LBP subjects
39.55 +/- 36.31 (trial 1)
36.64 +/- 33.32 (trial 2)
Healthy, pain-free subjects
77.76 +/- 36.63 (trial 1)
72.73 +/- 29.79 (trial 2)
Sjolie et al., 2001
n=88; At baseline: No LBP: All 3.4 (.7) min, Girls 3.7 (.5) min, Boys 3.3 (.7) min; LBP 1-30 days: All 3.2 (.9) min, Girls 3.3 (1) min, Boys 3.1 (.8) min; LBP >30 days: All 2.6 (1) min, Girls 2.6 (1.2) min, Boys 2.5 (.8) min
n=85S; At 3 year follow up assessment: No LBP: All 3.3 (.7) min, Girls 3.4 (.8) min, Boys 3.3 (.7) min; LBP 1-30 days: All 3.1 (.9) min, Girls 3.3 (1) min, Boys 2.9 (.9) min; LBP >30 days: All 2.5 (1.1) min, Girls 2.4 (1.3) min, Boys 2.6 (1.0) min
McGill et al., 1999 (n= 75)
Males = 146s ±51s
Females = 189s ±60s
Keller et, al., 2001
Excellent test-retest reliability (ICC = 0.93) for CLBP
Excellent test retest reliability (ICC = 0.80) for healthy population
Mannion et al., 1997
Excellent test-retest reliability (ICC = .98)
Moffroid et al., 1993
Excellent test-retest reliability (ICC= 0.87)
Moffroid, 1997
Excellent test-retest reliability for active subjects (ICC=0.96)
Poor test-retest reliability for inactive subjects (ICC=0.39)
McGill et al., 1999
Excellent test-retest reliability (ICC=0.98) with reliability testing conducted 8 weeks apart on random subjects (n=5)
Excellent test-retest reliability (ICC=0.99) for all subjects (n=75), including reliability testing
Simmonds et, al. 1998
Excellent test-retest reliability (ICC = 0.91) for LBP group
Adequate test-retest reliability (ICC = 0.73) for healthy control group
Latimer et al., 1999
Excellent interrater reliability w 95% CI
For all subjects (n=63) ICC=0.85
Subjects with current Non-Specific LBP ICC=0.88
Subjects with prior NSLBP ICC=0.77
Subjects with no prior LBP ICC=0.83
Excellent interrater reliability w 95% CI
Active subjects ICC=0.86
Inactive subjects ICC=0.82
Salminen et al., 1995
Excellent Interrater reliability (ICC= 0.88)
Simmonds et, al., 1998
Excellent interrater reliability (ICC=0.99) for both LBP and control groups
Sjolie et al., 2001
Predictive Validity:
Adams, 1999
Significant predictive validity for lack of Serious LBP at 36 months (R=-0.01)
|
|
12 Months |
36 Months |
|
Serious LBP |
-0.133 |
-0.010 |
|
Any LBP |
0.486 |
-0.058 |
Demoulin et al., 2006
Less than 176s predicted low back pain for individuals within the next year.
Greater than 198s predicted absence of low back pain.
If the individual did not have pain or difficulty, the test was terminated after 240s.
Concurrent Validity:
Sjolie et al., 2001
Statistically significant association between Biering-Sorensen endurance time and self report of LBP history at baseline in adolescents (p= .006)
Statistically significant association between Biering Sorensen endurance time at 3 year follow up assessment and LBP in adolescents (p= .007)
Convergent Validity:
Adams et, al., 1999
Beiring-Sorensen for fatigability correlated with back muscle strength (p<0.05)
Kankaanpaa, 1998
Questionable validity to specifically measure paraspinal muscle fatigability
Mannion et al., 1997
Excellent correlation of Beiring-Sorensen endurance time with rate of decline in 4 site median frequency surface EMG (MF grad) power spectrum (R= .88, p=.0001)
Discriminant Validity:
Keller et al. , 2001
Statistically significant difference in performance of LBP patients and healthy controls (p<0.001, p<0.01)
Simmonds et al., 1998
Simmonds et. al, 1998
Minimum 0.49 seconds, all patients at least on the scale so suggests no floor effect
Demoulin et al., 2006
Latimer et al.
All participants: Small (ES= -0.002)
Current LBP: Small (ES= -0.02)
Previous LBP: Small (ES= 0.05)
Asymptomatic LBP: Moderage (ES= -0.32)
Mannion, et al.
All participants: Moderate (ES=0.34)
Physiotherapy group: Moderate (ES=0.23)
Aerobic Exercise Group: Small (ES=0.04)
Device Group: Moderate (ES= 0.38)
Adams, M. Mannion A., Dolan, P.(1999). “Personal Risk Factors for First-Time Low Back Pain.” Spine. (24) 23.
Alaranta H, Hurri H, Heliovaara M, Soukka A, Harju R. (1994). “Non-dynamometric trunk performance tests: reliability and normative data.” Scand J Rehabil Med. 26: 211-5.
Biering-Sorensen F.(1984). “Physical measurements as risk indicators for low-back trouble over a one-year period.” Spine. 9: 106-19.
Demoulin, C., Vanderthommen, M., Duysens, C., Crielaard, C.M. (2006). “Spinal muscle evaluation using the sorensen test: a critical appraisal of the literature.” Joint Bone Spine. 73: 43-50.
Holmstrom E, Mortiz U, Andersson M. (1992). “Trunk muscle strength and back muscle endurance in construction workers with and without low back disorder.” Scand J Rehabil Med. 24:3-10.
Hultman G, Nordin M, Saraste H, Ohlsen H. (1993). “Body composition, endurance, strength, cross-sectional area, and density of MM erector spinae in men with and without low back pain.” J Spinal Disord. 6: 114-23.
Kankaanpaa, B.M., et al. (1998). “Age, sex, and body mass index as determinants of back and hip extensor fatigue in the isometric Sørensen back endurance test.” Arch Phys Med Rehabil. 79: 1069-1075.
Keller, A., Hellesnes, J., & Brox, J. I. (2001). “Reliability of the isokinetic trunk extensor test, Biering-Sørensen test, and Åstrand bicycle test: Assessment of intraclass correlation coefficient and critical difference in patients with chronic low back pain and healthy individuals.” Spine. 26(7): 771-777.
Latimer, Jane, et al. (1999). "The reliability and validity of the Biering–Sorensen test in asymptomatic subjects and subjects reporting current or previous nonspecific low back pain." Spine 24.20: 2085-2090.
Luoto, S., et al. (1995) "Static back endurance and the risk of low-back pain." Clinical biomechanics. 10.6: 323-324.
Mannion, A.F., Connolly, B., Wood, K., Dolan, P. (1997) “The use of surface EMG power spectral analysis in the evaluation of back muscle function.” Journal of Rehabilitation Research and Development. 34(4):427-439.
Mannion AF, Dolan P. (1994). “Electromyographic median frequency changes during isometric contraction of the back extensors to fatigue.” Spine. 19: 1223-9.
Mannion, A.F., Taimela, S., Muntener, M., Dvorak, J. (2001). “Active therapy for chronic low back pain part 1. Effects on back muscle activation, fatigability, and strength.” Spine. 26(8): 897-908.
McGill, S.M, Childs, A., Liebenson, C. (1999). “Endurance Times for Low Back Stabilization Exercises: Clinical Targets for Testing and Training From a Normal Database.” Arch Phys Med Rehabil. 80: 941-944.
Moffroid, M.T. (1997). “Endurance of trunk muscles in persons with chronic low back pain: Assessment, performance, training.” Journal of Rehabilitation Research and Development. 34: 440-447.
Moffroid, M.T., Haugh, L.D., Haig, A.J., Henry, S.M., Pope, M.H. (1993). “Endurance Training of Trunk Extensor Muscles.” Phys. Ther. 73: 3-10.
Salminen, J.J., Erkintalo Tertti, M., Laine, M., Pentti, J. (1995). “Low Back Pain in the Young: A Prospective Three-Year Follow-up Study of Subjects With and Without Low Back Pain.” Spine. 20(19): 2101-2108.
Simmonds MJ, Olson SL, Jones S, Hussein T, Lee CE, Novy D, et al. (1998). “Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain.” Spine. 23:2412-21.
Sjölie, Astrid N., and Anne E. Ljunggren (2001). "The significance of high lumbar mobility and low lumbar strength for current and future low back pain in adolescents." Spine 26.23: 2629-2636.
Takala, E. P., Vikari-Juntura, E. (1999). “Do functional tests predict low back pain.” Spine 25(16): 2126-2132.
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