Cut-off point for diagnosing thoraco-lumbo-pelvic rotation range hypomobility through the leg lateral reach test in chronic low back pain: a cross-sectional study

Authors

Keywords:

Chronic pain, Rapid diagnostic tests, ROC curve, Spine, Musculoskeletal pain, Leg lateral reach test, Chronic low back pain, Musculoskeletal system

Abstract

BACKGROUND: Studies have proposed using the leg lateral reach test (LLRT). However, they did not establish a cut-off point for testing.

OBJECTIVE: To establish a cut-off point for the thoraco-lumbo-pelvic rotation range using the LLRT in patients with chronic low back pain.

DESIGN AND SETTING: Cross-sectional study conducted in Buriticupu, Maranhão, Brazil.

METHODS: In the chronic low back pain group (LBPG, n = 35), we included patients aged 18 to 59 years, of both sexes, with scores ≤ 4 on the Baecke Habitual Physical Activity Questionnaire, body mass indeces ≤ 26 kg/m2, disability levels ≥ 3 on the Roland-Morris Disability Questionnaire, and pain levels ≥ 3 on the Numeric Pain Rating Scale. In the healthy control group (HCG, n = 35), the patients had the same characteristics (except for pain and disability). We used receiver operating characteristic curves to check the rate of true versus false positives in different LLRT ranges of motion and found the best LLRT cut-off point using the following mathematical model: (1 – sensitivity)2 + (1 – specificity)2.

RESULTS: The sample was mainly composed of females (HCG = 65.71%; LBPG = 82.85%, P = 0.101), and 68.42% of the characteristics (13 of 19 comparisons between groups) showed a significant difference (P ≤ 0.05), with an effect size ranging from moderate to large (Cohen’s d ≥ 0.5). The cut-off value for ideal sensitivity and specificity was ≤ 82.85 cm.

CONCLUSION: Patients with chronic low back pain and an LLRT range ≤ 82.85 cm have hypomobility regarding thoraco-lumbo-pelvic rotation range.

Downloads

Download data is not yet available.

Author Biographies

André Pontes-Silva, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, Brazil

BPE. MSc. PhD. Researcher. Postgraduate Program in Physical Therapy, Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.

Aldair Darlan Santos-de-Araújo, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, Brazil

PT. PhD student, Postgraduate Program in Physical Therapy, Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.

Mariana Schamas-Esposel, Universidade Federal de São Paulo (Unifesp), São Paulo, São Paulo, Brazil

BSc Kin. Researcher, Department of Anesthesiology, Pain and Intensive Care Medicine, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil.

Aliny da Silva de Araujo, Faculdade Santa Terezinha, São Luís, Maranhão, Brazil

PT. Researcher, Department of Physical Therapy, Faculdade Santa Terezinha, São Luís (MA), Brazil.

Giovanna Laura Neves Antonio Gaban, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, Brazil

PT. PhD student, Postgraduate Program in Physical Therapy, Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.

Almir Vieira Dibai Filho, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil

PT. PhD. Professor, Postgraduate Program in Physical Education, Department of Physical Education, Universidade Federal do Maranhão (UFMA), São Luís (MA), Brazil; Professor, Postgraduate Program in Adult Health, Universidade Federal do Maranhão (UFMA), São Luís (MA), Brazil.

References

Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021;398(10294):78-92. PMID: 34115979; https:// doi.org/10.1016/s0140-6736(21)00733-9.

GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789-858. PMID: 30496104; https://doi. org/10.1016/s0140-6736(18)32279-7.

Pontes-Silva A, Avila MA, de Araujo ADS, et al. Assessment of the reliability of the leg lateral reach test to measure thoraco-lumbo-pelvic rotation in individuals with chronic low back pain. J Manipulative Physiol Ther. 2021;44(7):566-72. PMID: 35282857; https://doi.org/10.1016/j. jmpt.2021.12.001.

Kim SH, Kwon OY, Park KN, Hwang UJ. Leg lateral reach test: the reliability and correlation with thoraco-lumbo-pelvic rotation range. J Sci Med Sport. 2017;20(1):2-5. PMID: 27210501; https://doi.org/10.1016/j.

jsams.2016.04.006.

Pontes-Silva A. Letter to the Editor Regarding: “Padilha VH, et al. Lumbopelvic Muscle Mobility and Resistance and Their Association with

Musculoskeletal Pain in Ballet Dancers. Rev Bras Ortop. 2023;58(3):4106”. Rev Bras Ortop. 2024;59(5):e806-8. PMID: 39649050; https://doi. org/10.1055/s-0044-1787771.

Bossuyt PM, Reitsma JB, Bruns DE, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ. 2015;351:h5527. PMID: 26511519; https://doi.org/10.1136/bmj.h5527.

Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91. PMID: 17695343; https://doi.org/10.3758/bf03193146.

Wadhwa RR, Marappa-Ganeshan R. T Test. Treasure Island: StatPearls, 2023. PMID: 31971709.

Segerstrom SC. Statistical Guideline No. 5. Include Results of a Power Analysis; if a Power Analysis Was Not Performed, Describe the Stopping Rule for Recruitment. Int J Behav Med. 2020;27(2):140-1. PMID: 32140932; https://doi.org/10.1007/s12529-020-09868-7.

Pontes-Silva A. Statistical significance does not show clinical relevance: we need to go beyond the P-value. J Clin Exp Hepatol. 2022;12(5):1402. PMID: 36325112; https://doi.org/10.1016/j.jceh.2022.04.017.

Cohen J. Statistical power analysis for the behavioral sciences. New York: Routledge; 2013. https://doi.org/10.4324/9780203771587.

Primer AP. Quantitative methods in psychology. Psychol Bull

;112(1):155-9. PMID: 19565683; https://doi.org/10.1037//00332909.112.1.155.

Florindo AA, Latorre MdoR, Jaime PC, Tanaka T, Zerbini CA. Methodology to evaluation the habitual physical activity in men aged 50 years of more. Rev Saude Publica. 2004;38(2):307-14. PMID: 15122389; https:// doi.org/10.1590/s0034-89102004000200022.

Pontes-Silva A. Comment on “Relationship between different body composition and bone mineral density in Qinhuangdao city”. Rev Assoc Med Bras. 2022;68(10):1360. PMID: 36417633; https://doi.org/10.1590/1806-9282.20220556.

Pontes-Silva A, Bassi-Dibai D, Fidelis-de-Paula-Gomes CA, et al. Comparison of the autonomic nervous system dysfunction between different chronic spine disorders: neck pain versus low back pain. Rev Assoc Med Bras. 2022;68(9):1288-96. PMID: 36228260; https://doi. org/10.1590/1806-9282.20220406.

Nusbaum L, Natour J, Ferraz MB, Goldenberg J. Translation, adaptation and validation of the Roland-Morris questionnaire - Brazil Roland-Morris. Brazilian J Med Biol Res. 2001;34(2):203-10. PMID: 11175495; https:// doi.org/10.1590/s0100-879x2001000200007.

Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. Pain. 2011;152(10):2399-404. PMID: 21856077; https://doi.org/10.1016/j.pain.2011.07.005.

Pontes-Silva A. Letter to the Editor Regarding ‘Deriving a Novel Score for the Stratification of Risk Progression in Early-onset Scoliosis: A

Multicenter Initiative’ by Dr. André Pontes-Silva. Spine. 2023;48(17):E306.

PMID: 37093082; https://doi.org/10.1097/brs.0000000000004689.

Pontes-Silva A, Lopes AL, Maciel ES, Quaresma FRP, Dibai AV Filho. Human metabolism and body composition: prospects for novel studies. Nutr Rev. 2023;82(1):5-8. PMID: 38073333; https://doi.

org/10.1093/nutrit/nuad040.

Valdez R. A simple model-based index of abdominal adiposity.

J Clin Epidemiol. 1991;44(9):955-6. PMID: 1890438; https://doi. org/10.1016/0895-4356(91)90059-i.

Nicholas MK. The pain self-efficacy questionnaire: Taking pain into account. Eur J Pain. 2007;11(2):153-63. PMID: 16446108; https://doi. org/10.1016/j.ejpain.2005.12.008.

da Silva IH, da Silva Junior JM, Santos-de-Araújo AD, et al. Intra- and interreliability of fleximetry in individuals with chronic shoulder pain. Phys Ther Sport. 2018;32:115-20. PMID: 29778827; https://doi.org/10.1016/j. ptsp.2018.05.011.

Pontes-Silva A. Dry needling is not superior to sham and/or no intervention for fibromyalgia when the trial is analyzed using the intention-to-treat principle and linear mixed models. PM R. 2025 Aug 11. Ahead of print. PMID: 40787809; https://doi.org/10.1002/ pmrj.70004.

Pontes-Silva A. Evidence-based health: mathematical strategies for translating scientific findings into routine clinical care. Rev Assoc Med Bras. 2023;69(12):e20230935. PMID: 37971135; https://doi. org/10.1590/1806-9282.20230935.

Akobeng AK. Understanding diagnostic tests 3: Receiver operating characteristic curves. Acta Paediatr. 2007;96(5):644-7. PMID: 17376185; https://doi.org/10.1111/j.1651-2227.2006.00178.x.

Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J. 2005;47(4):458-72. PMID: 16161804; https://doi.org/10.1002/bimj.200410135.

Deeks JJ, Altman DG. Diagnostic tests 4: likelihood ratios. BMJ. 2004;329(7458):168-9. PMID: 15258077; https://doi.org/10.1136/ bmj.329.7458.168.

Abd Rahman NA, Li S, Schmid S, Shaharudin S. Biomechanical factors associated with non-specific low back pain in adults: a systematic review. Phys Ther Sport. 2023;59:60-72. PMID: 36516512; https://doi. org/10.1016/j.ptsp.2022.11.011.

Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79-86. PMID: 30826805; https://doi.org/10.1136/ bjsports-2018-099878.

Park W-H, Kim YH, Lee TR, Sung PS. Factors affecting shoulder-pelvic integration during axial trunk rotation in subjects with recurrent low back pain. Eur spine J. 2012;21(7):1316-23. PMID: 22456800; https:// doi.org/10.1007/s00586-012-2280-5.

Tierney JF, Vale C, Riley R, et al. Individual Participant Data (IPD) Metaanalyses of Randomised Controlled Trials: Guidance on Their Use. PLoS Med. 2015;12(7):e1001855. PMID: 26196287; https://doi.org/10.1371/ journal.pmed.1001855.

Downloads

Published

2026-01-29

How to Cite

1.
Pontes-Silva A, Santos-de-Araújo AD, Schamas-Esposel M, Araujo A da S de, Gaban GLNA, Dibai Filho AV. Cut-off point for diagnosing thoraco-lumbo-pelvic rotation range hypomobility through the leg lateral reach test in chronic low back pain: a cross-sectional study. Sao Paulo Med J [Internet]. 2026 Jan. 29 [cited 2026 Apr. 23];144(1):1-8. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/3608

Issue

Vol. 144 No. 1 (2026)

Section

Original Article

License

Copyright (c) 2026 São Paulo Medical Journal

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.