Passive segmental motion tests (PAIVM, PPIVM, and PIT) are widely used to investigate local mobility, stiffness, and symptom reproduction in people with low back pain (LBP).
Despite this fact, their validity and reliability has been a matter of debate. Additionally, previous reviews have failed to provide systematic evidence-based recommendations for their use.
A literature search yielded thirteen studies eligible for review which assessed the validity and reliability of the PAIVM, PPIVM, and PIT. Study risk of bias as assessed by the Quality Assessment of Diagnostic Accuracy Studies and Quality Appraisal of Reliability Studies ranged from low to high.
The overall clinical recommendation for the use of the analysed tests ranged between no and moderate recommendation; no isolated test had a strong recommendation.
The proposed reasons for these findings were the small magnitude of intervertebral movements, which may prevent them from being reliably identified by therapists, and the impossibility of producing only individual segment movement during these tests, since adjacent segments also move.
The recommendation is that these tests are used in combination with other clinical information from patient examination.
> From: Stolz et al., Musculoskelet Sci Pract 45 (2020) 102076 (Epub ahead of print). All rights reserved to Elsevier Ltd. Click here for the online summary.
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Expert opinion
The notion that individual vertebral movement can be induced or accurately evaluated seems to be at least doubtful given the structural integrity and anatomy of the spine.
Nevertheless, such notions are widely used to perform tests, which in turn serve as the basis for treatment decisions. If treatment decisions are based on unreliable information, can treatment outcomes be adequately attributed to the intervention?
This review warrants us to take a step back and reconsider the thought process behind some practice standards. The full text is free to access, which is another reason not to give this one a pass.
