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Functional Status

Assessment of spinal functional status, including pain and ADL metrics, with a focus on recovery definitions and ambulatory potential in SCI.

Overview

Primary total hip arthroplasty is indicated for patients regardless of age, gender, or location [1]. However, preoperative functional status serves as a critical determinant of prognosis; functionally dependent patients face significantly higher risks of mortality, adverse perioperative outcomes, and complications [4, 19]. While patients with worse preoperative status may derive greater benefit from the procedure, their final functional outcomes are generally inferior to those of patients with better baseline status [26].

In acute traumatic spinal cord injury, age and baseline AMS are the primary predictors of functional outcome [2]. Similarly, early retirement due to injury correlates with worse disability, quality of life, and functional outcomes following upper extremity replantation or revascularization [5]. For musculoskeletal disorders, rehabilitation improves functional ability and health-related quality of life [3], though most HRQOL score improvements after kyphectomy in myelomeningocele patients fall below the minimum clinically important difference [8].

Accurate assessment requires robust measurement tools; the Musculoskeletal Function Assessment Questionnaire demonstrates superior responsiveness and efficiency compared to the SF-36 for tracking functional changes [7]. Proxy-reported outcomes may better characterize impairment and pain in elderly musculoskeletal injury patients, potentially reducing selection bias [12]. Future studies should utilize the WHO ICF framework to select outcome measures that capture all components necessary for understanding functional return and planning interventions [6].

Anatomy & Pathophysiology

Kinematics and Biomechanics

With advancing age, spinopelvic biomechanics demonstrate decreased spinal mobility and increased pelvic/hip mobility [29]. There is an association between hip-pelvic kinematics and future low back pain in youth floorball and basketball players [30], while four subgroups of lumbo-pelvic flexion kinematics are present in people with and without persistent low back pain [34]. Large lumbar spine fusion or high-grade lumbosacral transitional vertebrae (LSTV) is probably the most deleterious to spinal mechanics and outcomes following hip arthroscopy [47], whereas low-grade LSTV with maintained spinopelvic motion is perhaps not critical for outcomes following hip arthroscopy [47]. Pain reduction did not alter lumbar range of motion, angular velocity, angular acceleration, or movement irregularity [43]. The sacral slope (SS) is the pelvic functional parameter showing the highest correlation with patient-specific pelvic morphology (pelvic incidence) in standing and sitting positions [55].

Assessment Modalities

Wearable Sensors: Currently available wearable devices are capable of assessing spinal posture with good accuracy in the clinical setting [36], and there is a clinically acceptable level of agreement between the ViMove wireless motion sensor system and the Vicon motion capture system for measuring standing lumbar inclination motion in the sagittal and coronal planes [46]. Lumbar spinal motion measurements and position determination between different operators can be consistent, particularly if utilizing the modified instrument [49]. Rasterstereography: This modality is a valuable tool for the dynamic evaluation of spinal posture and pelvic position [40] and can be used to quantify motion in the spine [40]. Photography: Photographs provide valid and reliable indicators of the position of the underlying spine in sitting [52]. Motor Control: Altered movement patterns in the cervical spine were found for both whiplash and chronic neck pain groups, indicating changes in motor control strategies [58], and wearable technologies and biofeedback modalities are used to modulate spine motor control [50]. Occupational Posture: Typical patterns of postures during dental treatment tasks include higher angular values in the cervical and thoracic spine compared to other dental tasks [53]. Research Gaps: There is a lack of current research to establish the psychometric properties of non-invasive 3D human posture-measuring instruments [60].

Classification

Patient Demographics and Baseline Status: Patient age, gender, and location do not influence the functional status at which patients are indicated for primary total hip arthroplasty [1]. In acute traumatic spinal cord injury, age and baseline AMS play the most important role in predicting functional outcome [2]. For knee symptom evaluation systems, demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores [9].

Pain and Disability Instruments: The NDI is the best instrument for measuring neck pain-related disability because its results are the most consistent with patient assessment of their own clinical status and evolution [10]. The MCID is baseline score dependent but only in certain subpopulations for pain and disability instruments in low back pain patients [28].

Low Back Pain Subgroups and Risk Stratification: The Quebec Task Force categories identify different low back pain subgroups at baseline and there is a consistent ranking of the four categories with respect to outcomes [42]. Distinct patterns of association were demonstrated between clinical, psychosocial, and sociodemographic factors and ICF domains in adults with chronic non-specific low back pain [16]. A risk classification schema using recommended cut-off scores with items similar to the STarT-Back in a primary care population with strictly defined acute low back pain had limited ability to identify persons who progressed to chronic pain [54].

Rotator Cuff and Tendon Repair: No differences in clinical scores existed between patients stratified by the Sugaya MRI classification system at 16 weeks after rotator cuff repair [11]. Classification of angular measurement according to tested systems does not reflect the patient's perspective, limits the precision of the measurement, and adds little value to the measurement itself after flexor tendon repair [38]. The authors' modification of the Gilbert grading system appears to be valid and applicable for tendon transfer for treatment of internal rotation contracture of the shoulder in brachial plexus birth palsy [61].

Greater Trochanteric Pain Syndrome: The classification system and treatment algorithm for surgical treatment of various greater trochanteric pain syndrome types leads to favorable patient-reported outcomes [48].

Other Considerations: Functional ability and health-related quality of life improved after rehabilitation in patients with musculoskeletal disorders [3]. Patients prescribed full, graded, or no sick leave exhibited significant, albeit not clinically meaningful, reductions in pain-related disability over a six-month period [13]. Future COVID-19 follow-up studies should use the ICF framework to select a combination of outcome measures that capture all components for better understanding of impact on survivors and planning interventions to maximize functional return [6].

Clinical Presentation

Functional status assessment must account for demographic and clinical variables that influence baseline presentation and outcomes. While patient age, gender, and location do not influence the functional status at which patients are indicated for primary total hip arthroplasty [1], demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores on knee symptom evaluation systems [9]. In acute traumatic spinal cord injury, age and baseline AMS play the most important role in predicting functional outcome [2]. Conversely, patients with long-standing hip and groin pain may present with worse self-reported outcomes but no limitations in performance-based measures compared with healthy controls [35].

Objective assessment of walking ability provides baseline data and objective information that are more precise than the patients' own subjective estimates [31]. However, gait metrics demonstrated weak to moderate correlations with patient-reported outcomes at 3 and 6 months after hip arthroscopy [17]. For neck pain disability, the Neck Disability Index (NDI) results are the most consistent with patient's assessment of their own clinical status and evolution [10]. The Musculoskeletal Function Assessment Questionnaire was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values [7], while the Swedish version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA-Swe) may be used in clinical settings to provide reliable and valid assessments of the health status of an individual patient [32].

Functional dependence is a significant predictor of increased risk of complications and post-operative mortality after elective cervical spine surgery [4]. Patients who had to retire early exhibited worse disability, quality of life, and functional outcome after replantation or revascularisation in the upper extremity [5]. Continuing pain might lead to lasting functional impairment despite good mechanical outcomes after surgical treatment of symptomatic nonunion and malunion of midshaft clavicle fractures [15]. Most HRQOL score improvements after kyphectomy for myelomeningocele were below the minimum clinically important difference [8]. Patients with remission or mild fibromyalgia experience more severe symptoms and poorer quality of life than patients with remission or low disease activity rheumatoid arthritis [18].

Distinct patterns of association were demonstrated between clinical, psychosocial, and sociodemographic factors and ICF domains in adults with chronic non-specific low back pain [16]. Patients with musculoskeletal disorders demonstrated mild complaints at baseline and an overall stable course during one-year follow-up [20]. Functional ability and health-related quality of life improved after rehabilitation in patients with musculoskeletal disorders [3]. Patients prescribed full, graded, or no sick leave exhibited significant, albeit not clinically meaningful, reductions in pain-related disability over a six-months period [13]. The use of proxy-reported patient-reported outcomes might better characterize functional impairment and pain in a vulnerable patient population and could decrease selection bias in outcomes research [12]. Using specified diagnosis is important in sick leave research, planning of treatment and rehabilitation, and evaluation of prognosis for common musculoskeletal disorders [37].

Investigations

Plain radiography: Preoperative assessment of segmental instability in degenerative lumbar spondylolisthesis demonstrates a significant advantage when combining normal sitting radiographs with supine sagittal MR images during the five-repetition sit-to-stand test [67]. In adolescents with idiopathic scoliosis, scoliosis-specific exercises yield a mean improvement in Cobb angle of less than 5 degrees [81]. Associations between x-ray features of lumbar disc degeneration and the severity of disability or intensity of pain remain inconclusive [57].

MRI: Age and baseline AMS are the primary predictors of functional outcome in acute traumatic spinal cord injury [2]. In patients with myelomeningocele, most health-related quality of life score improvements following kyphectomy fall below the minimum clinically important difference [8], and while some young non-functional ambulators improve, the general trend is deterioration with surgery extent failing to significantly alter outcomes [21]. MRI findings lack major clinical relevance when evaluating walking distance in lumbar spinal stenosis [27]. No differences in clinical scores exist between patients stratified by the Sugaya MRI classification system at 16 weeks post-rotator cuff repair [11]. Early MRI is associated with increased length of disability in acute lower back pain without red flags [56]. Preoperative multifidus fatty infiltration serves as a good predictor for assessing functional status improvement in lumbar spinal stenosis [63].

Other Considerations: Patient age, gender, and location do not influence the functional status at which patients are indicated for primary total hip arthroplasty [1]. Gait metrics show weak to moderate correlations with patient-reported outcomes at 3 and 6 months after hip arthroscopy [17]. The minimal clinically important difference is baseline score dependent but only in certain subpopulations of low back pain patients [28]. Psychological factors outmatch morphological markers in predicting limitations in activities of daily living and participation in lumbar stenosis [69]. Spinal fusion in patients with GMFCS IV or V cerebral palsy results in durable radiographic correction and sustained improvements in caregiver-reported quality of life over a minimum of 5 years [65]. Overall bone metabolism of the operated intervertebral disc space at six weeks has the highest diagnostic accuracy for predicting fusion status at one year after posterior lumbar interbody fusion [68]. Diagnostic tests for lumbar instability are simple, reliable, and safe, recommended for physical therapists to assess suspected patients without immediate X-ray assessment [75]. Clinically important outcome values for the iHOT-12, HOOS, and HOOS global assist in interpreting clinical change during nonoperative treatment for nonarthritic hip-related pain [80].

Treatment

Non-Operative

Conservative strategies including physical therapy, stabilizing exercises, and manual therapy can improve function and pain, particularly when combined for postural corrections [45]. Targeting self-efficacy contributes to rapid functional improvement in selected, motivated patients with persistent chronic low back pain [33]. High-quality studies are warranted to establish non-surgical treatment as an evidence-based alternative for conditions related to excessive anterior pelvic tilt [72]. For complete proximal hamstring avulsions, any conclusion comparing operative and non-operative management remains limited by a dearth of non-operative studies and high risk of bias [70].

Operative

Indications: Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in childhood coxa vara, whereas moderate nonprogressive deformity often does not require surgery [71]. Patients with worse preoperative status may derive greater benefit from total hip arthroplasty, though their absolute outcomes may not match those of patients with better preoperative status [26]. Surgery is indicated for Duchenne muscular dystrophy with scoliosis to improve function and decrease the rate of forced vital capacity deterioration compared to conservative treatment [78]. Patients should be provided realistic expectations that continuing pain may lead to lasting functional impairment despite good mechanical outcomes after surgical treatment of symptomatic nonunion and malunion of midshaft clavicle fractures [15].

Surgical Approach / Technique: Functional improvements can be achieved with both nonsurgical and surgical strategies for elbow stiffness [76]. Palmar and lateral grasp, among other functions, can be reliably restored with implanted neuroprostheses in tetraplegic patients, leading to significant improvements in functional capacity [44]. While some young non-functional ambulators with myelomeningocele improved after surgery, the general trend was deterioration, and the extent of surgery did not significantly alter outcomes [21]. Most HRQOL score improvements after kyphectomy in patients with myelomeningocele were below the minimum clinically important difference, and the procedure should be avoided when possible [8].

Other Considerations: Patient age, gender, and location do not influence the functional status at which patients are indicated for primary total hip arthroplasty [1]. Functional dependence is a significant predictor of increased risk of complications and post-operative mortality after elective cervical spine surgery [4]. Patients who retired early demonstrated worse disability, quality of life, and functional outcome after replantation or revascularisation in the upper extremity [5]. Preoperative management of modifiable risk factors may decrease length of inpatient stay, rates of disposition to non-home facilities, and total cost of care after shoulder arthroplasty [64]. Positive expectations regarding pain and the fulfillment of expectations concerning functional domains predicted higher global effectiveness ratings after total hip arthroplasty [41]. Asymptomatic pelvic ring injured patients show minimal, if any, evidence of impaired functional outcome following successful reduction of a posterior pelvic disruption treated by CRPSF, despite having subclinical alterations in gait [74].

Setting of Care: Evaluation of all aspects of physical performance following lumbar decompression surgery is recommended [62]. A high proportion of patients with severe low back pain did not reach WHO recommendations on physical activity before lumbar fusion surgery, placing them at risk of poor health due to insufficient physical activity [59]. Age and baseline AMS play the most important role in predicting functional outcome in acute traumatic spinal cord injury [2]. Two prognostic models containing partially different predictors were developed for predicting (non-)recovery in patients with acute low back pain, with acceptable performance better than current practice [66].

Adjuncts: Future follow-up studies should use the WHO ICF framework to select a combination of outcome measures that capture all components for a better understanding of impact on survivors and planning interventions to maximize functional return [6]. The Minnesota Activity Scale provides standardized questions to comprehensively assess return to activity as a marker of treatment effectiveness [39]. The Musculoskeletal Function Assessment Questionnaire was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values [7]. Functional ability and health-related quality of life improved after rehabilitation in patients with musculoskeletal disorders [3].

Complications

Other Considerations: Functional dependence significantly predicts increased risk of complications and post-operative mortality following elective cervical spine surgery [4]. Similarly, functionally dependent patients undergoing total hip arthroplasty face higher risks of mortality, adverse perioperative outcomes, and complications [19]. Poor baseline physical capability correlates with a higher risk of mortality over a 20-year period [25], while poor physical functioning may precipitate functional dependence, accelerated bone loss, and an increased risk for falls, injuries, and fractures [77]. In older women, muscle weakness is associated with a history and risk of falling [73]. Demographic variables including advanced age, low family income, and multiple medical conditions significantly affect scores on knee symptom evaluation systems [9]. Patient age, gender, and location do not influence the functional status at which patients are indicated for primary total hip arthroplasty [1].

Regarding long-term functional outcomes and quality of life, age and baseline AMS play the most important role in predicting functional outcomes of acute traumatic spinal cord injury [2]. Patients with idiopathic scoliosis demonstrated significantly decreased health-related quality of life and capacity to work 40 years after diagnosis [23]. In upper extremity trauma, patients who retired early exhibited worse disability, quality of life, and functional outcomes after replantation or revascularisation [5]. Limb salvage for osteosarcoma of the distal femur did not provide a measurable benefit in the quality of life of survivors at long-term follow-up [14]. Conversely, functional ability and health-related quality of life improved after rehabilitation in patients with musculoskeletal disorders [3]. Revision rotator cuff reconstruction improves clinical outcomes and shoulder function at midterm follow-up [24]. Primary reverse shoulder arthroplasty provides good early functional results, reliable pain control, and excellent restoration of an independent lifestyle in elderly patients with complex fractures of the proximal humerus [79].

Recovery

Light activity (weeks): Evidence does not specify a discrete week range for light activity initiation; however, functional ability and health-related quality of life improve following rehabilitation in structured national programs for musculoskeletal disorders [3]. Patients with arm, neck, and shoulder complaints typically demonstrate mild baseline complaints and a stable course over one year [20].

Full activity (months): Revision rotator cuff reconstruction improves clinical outcomes and shoulder function at midterm follow-up with a minimum of 2 years' follow-up [24]. Patients with a preoperative duration of symptomatic medial knee overload or arthritis of two years or greater do not experience inferior patient-reported or clinical outcomes compared to those with symptom duration less than 2 years at mid-term follow-up after high tibial osteotomy [83].

Complete recovery / outcome plateau (months): Patients with idiopathic scoliosis exhibit significantly decreased health-related quality of life and work capacity 40 years after diagnosis [23]. Limb salvage compared with amputation for osteosarcoma of the distal femur did not provide a measurable benefit in quality of life at long-term follow-up [14]. Further studies with long-term follow-up are needed to determine whether the grafted area maintains structural and functional integrity over time after Autologous Matrix-Induced Chondrogenesis for focal cartilage defects in the knee [51].

Rehabilitation protocol: The WHO ICF framework is recommended for selecting outcome measures to capture all components for understanding impact on survivors and planning interventions to maximize functional return in long-term follow-up studies [6]. Baseline biopsychosocial characteristics influence trajectories and prognosis in a cumulative, dose-dependent manner for disability courses in chiropractic patients with low back pain [82].

Functional milestones: The Musculoskeletal Function Assessment Questionnaire is more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values [7]. The Measurement of Shoulder Activity Level can be completed quickly to define patient populations for cohort studies and assess activity level as a prognostic factor in patients with shoulder disorders [84].

Other Considerations: Patient age, gender, and location do not influence the functional status at which patients are indicated for primary total hip arthroplasty [1]. Age and baseline AMS play the most important role in predicting the functional outcome of acute traumatic spinal cord injury [2]. Functional dependence is a significant predictor of increased risk of complications and post-operative mortality after elective cervical spine surgery [4]. Patients who retired early had worse disability, quality of life, and functional outcome after replantation or revascularisation in the upper extremity [5]. Patients with remission or mild fibromyalgia experience more severe symptoms and poorer quality of life than patients with remission or low disease activity rheumatoid arthritis despite being in a mild activity or remission stage [18]. An intraoperative load sensor did not improve the early postoperative results of posterior-stabilized TKA for osteoarthritis with varus deformities [22]. The risk of mortality over a 20-year period is higher in individuals with poor baseline physical capability, which is associated with cardiovascular and musculoskeletal health disorders in older women [25].

Key Evidence

  • [L1] Patient age, gender, and location do not influence the functional status at which patients are indicated for surgery. (10.1016/j.arth.2021.08.016)
  • [L2] Age and baseline AMS play the most important role in predicting the functional outcome. (10.1186/s13018-022-03343-7)
  • [L3] Functional ability and health related quality of life improved after rehabilitation. (10.1186/1471-2474-14-57)
  • [L3] Functional dependence is a significant predictor of an increased risk of complications and post-operative mortality. (10.1302/0301-620x.99b6.bjj-2016-1149.r1)
  • [L3] Also, those who had to retire early had a worse disability, quality of life and functional outcome. (10.1186/1471-2474-15-73)
  • [L2] We recommend future COVID-19 follow-up studies to use the ICF framework to select a combination of outcome measures that capture all the components for a better understanding of the impact on survivors and planning interventions to maximize functional return. (10.3390/ijerph17186476)
  • [L3] It was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values. (10.2106/00004623-199709000-00006)
  • [L4] Most HRQOL score improvements were below the minimum clinically important difference, and the procedure should be avoided when possible. (10.1097/corr.0000000000000976)
  • [L4] Numerous scoring systems have been devised to evaluate patients who have symptoms related to the knee, but demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores. (10.2106/00004623-199706000-00009)
  • [L4] NDI seems to be the best instrument for measuring NP-related disability, since its results are the most consistent with patient's assessment of their own clinical status and evolution. (10.1186/1471-2474-9-42)
  • [L2] No differences in clinical scores existed between patients stratified by the Sugaya MRI classification system at 16 weeks. (10.1016/j.jse.2015.09.019)
  • [L2] The use of proxy-reported patient-reported outcomes might better characterize functional impairment and pain in a vulnerable patient population and could decrease selection bias in outcomes research. (10.5435/jaaos-d-17-00644)
  • [L3] Patients prescribed full, graded, or no sick leave exhibited significant, albeit not clinically meaningful, reductions in pain-related disability over a six-months period. (10.1186/s12891-025-08570-7)
  • [L3] However, it did not provide a measurable benefit in the quality of life of survivors at the time of the long-term follow-up. (10.2106/00004623-199405000-00004)
  • [L4] Patients should be provided with realistic expectations that continuing pain might lead to lasting functional impairment despite good mechanical outcomes. (10.1016/j.jse.2006.12.002)
  • [L4] Distinct patterns of association were demonstrated between clinical, psychosocial and sociodemographic factors and ICF domains. (10.1186/s12891-026-09499-1)
  • [L4] Gait metrics had weak to moderate correlations with patient-reported outcomes at 3 and 6 months. (10.1016/j.asmr.2023.100779)
  • [L4] Despite being in a mild activity or remission stage, RFM patients experience more severe symptoms and poorer QOL than RRA patients. (10.1186/s12891-025-08323-6)
  • [L3] Functionally dependent patients undergoing THA are at higher risk of mortality, adverse perioperative outcomes, and complications. (10.1016/j.arth.2018.12.037)
  • [L2] The results demonstrate mild complaints at baseline and an overall stable course during one-year follow-up. (10.1186/s12891-018-2116-5)
  • [L4] While some young non-functional ambulators improved, the general trend was deterioration, and the extent of surgery did not significantly alter outcomes. (10.2106/00004623-197355010-00014)
  • [L2] A long-term followup study with a large cohort is required. (10.1007/s00167-018-5314-7)
  • [L3] In this long-term follow-up study, we found a significantly decreased HRQoL and capacity to work in patients with an idiopathic scoliosis 40 years after diagnosis. (10.1302/0301-620x.105b2.bjj-2022-0897.r1)
  • [L4] Revision RCR improves clinical outcomes and shoulder function at midterm follow-up. (10.1177/0363546518786006)
  • [L2] The risk of mortality over a 20-year period is higher in individuals with poor baseline physical capability. (10.1186/s12891-021-04056-4)
  • [L3] The findings suggest that the worse a patient's preoperative status, the more he or she may benefit from total hip arthroplasty, but patients with worse preoperative status may not have as good an outcome as those with better preoperative status. (10.2106/00004623-200211000-00006)
  • [L3] MRI findings failed to show a major clinical relevance when evaluating the walking distance in patients with lumbar spinal stenosis and, therefore, should be treated with some caution as a predictor of walking distance. (10.1186/1471-2474-9-89)
  • [L2] The MCID is baseline score dependent but only in certain subpopulations. (10.1186/1471-2474-7-82)
  • [L3] With advancing age, spinopelvic biomechanics demonstrate decreased spinal mobility and increased pelvic/hip mobility. (10.1302/0301-620x.106b8.bjj-2023-1197.r1)
  • [L2] Our results suggest that there is an association between hip-pelvic kinematics and future LBP. (10.1186/s12891-020-03376-1)
  • [L4] Objective assessment of walking ability appeared to be an easy and feasible tool for measuring such limitations as it provides baseline data and objective information that are more precise than the patients' own subjective estimates. (10.1186/1471-2474-11-233)
  • [L3] Targeting self-efficacy contributes to fast improvement in functional status for selected and motivated patients with persistent chronic low back pain. (10.1186/s12891-021-04637-3)
  • [L4] Four subgroups of lumbo-pelvic flexion kinematics were revealed with an unequal distribution among people with and without a history of persistent LBP. (10.1186/s12891-018-2233-1)
  • [L3] The results highlight the need to identify performance-based measures sensitive to functional deficiencies in patients with long-standing hip and groin pain to complement patient-reported outcomes. (10.1007/s00167-016-4101-6)
  • [L1] Our findings suggest that currently available devices are capable of assessing spinal posture with good accuracy in the clinical setting. (10.1186/s12891-019-2430-6)
  • [L4] This underscores the importance of using specified diagnosis, in sick leave research as well as in planning of treatment and rehabilitation and evaluation of prognosis. (10.1186/1471-2474-15-176)
  • [L4] Classification of angular measurement according to the tested systems does not reflect the patient's perspective; it limits the precision of the measurement and adds little value to the measurement itself. (10.1016/j.jhsa.2018.06.010)
  • [L5] The Minnesota Activity Scale provides standardized questions to comprehensively assess return to activity as a marker of treatment effectiveness. (10.1016/j.jisako.2024.07.005)
  • [L4] Rasterstereography is a valuable tool for the dynamic evaluation of spinal posture and pelvic position, which can also be used to quantify motion in the spine and therefore it has the potential to improve the understanding and treatment of spinal pathologies. (10.1186/s13018-020-01825-0)
  • [L2] Positive expectation about pain and the fulfillment of expectations concerning functional domains predicted higher global effectiveness ratings. (10.1186/s12891-021-04040-y)
  • [L3] The Quebec Task Force categories identify different LBP subgroups at baseline and there is a consistent ranking of the four categories with respect to outcomes. (10.1186/s12891-017-1495-3)
  • [L4] The results demonstrate that pain reduction did not alter lumbar range of motion, angular velocity, angular acceleration or movement irregularity questioning the role of pain in lumbar kinematics. (10.1186/1471-2474-15-304)
  • [L5] Palmar and lateral grasp, among other functions, can be reliably restored, leading to significant improvements in functional capacity. (10.5435/00124635-200403000-00002)
  • [L1] However, the improvement in function and pain were more effective in the combined manual therapy and stabilizing exercises group compared to stabilizing exercises alone. (10.1186/s12891-019-2438-y)
  • [L3] We found a clinically acceptable level of agreement between these two methods for measuring standing lumbar inclination motion in these two cardinal movement planes. (10.1186/s12891-017-1489-1)
  • [L5] Large lumbar spine fusion or high-grade lumbosacral transitional vertebrae (LSTV) is probably the most deleterious to spinal mechanics and outcomes, while low-grade LSTV with maintained spinopelvic motion is perhaps not critical for outcomes following hip arthroscopy. (10.1016/j.arthro.2023.04.004)
  • [L3] This validation study supports that the classification system and treatment algorithm for surgical treatment of various GTPS types leads to favorable patient-reported outcomes. (10.1016/j.arthro.2021.01.058)
  • [L3] Results suggest that lumbar spinal motion measurements and position determination between different operators can be consistent particularly if utilizing the modified instrument. (10.1186/1471-2474-8-103)
  • [L1] The review identifies a range of wearable technologies and biofeedback modalities used to modulate spine motor control, highlighting the need for standardized reporting and further research to establish clinical efficacy. (10.1186/s12891-024-07867-3)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L3] The findings suggest that photographs provide valid and reliable indicators of the position of the underlying spine in sitting. (10.1186/1471-2474-9-113)
  • [L4] The kinematic analysis of dentists illustrates typical patterns of postures during tasks that are essential to the dental treatment of patients, with higher angular values in the cervical and thoracic spine during treatment compared to other dental tasks. (10.1186/s12891-016-1288-0)
  • [L2] A risk classification schema using the recommended cut-off scores with items similar to the STarT-Back in a primary care population with strictly defined acute LBP had limited ability to identify persons who progressed to chronic pain. (10.1002/ejp.615)
  • [L4] The sacral slope (SS) is the pelvic functional parameter showing the highest correlation with patient-specific pelvic morphology (pelvic incidence) in standing and sitting positions. (10.1016/j.arth.2016.09.015)
  • [L1] Early MRI is associated with increased length of disability in patients with acute LBP without red flags. (10.1186/s12891-021-04863-9)
  • [L4] Associations of x-ray features of LDD with severity of disability and intensity of pain are inconclusive. (10.1186/s12891-017-1562-9)
  • [L3] Altered movement patterns in the cervical spine were found for both pain groups, indicating changes in motor control strategies. (10.1186/1471-2474-9-90)
  • [L4] A high proportion of the patients did not reach the WHO recommendations on physical activity and are therefore at risk of poor health due to insufficient physical activity. (10.1186/s12891-018-2274-5)
  • [L1] There is a lack of current research to establish the psychometric properties of non-invasive 3D human posture-measuring instruments. (10.1186/1471-2474-12-93)
  • [L3] The authors' modification of the Gilbert grading system appears to be valid and applicable. (10.1177/1753193412451401)
  • [L4] The evaluation of all aspects of physical performance following lumbar decompression surgery is also recommended. (10.1186/s13018-023-04462-5)
  • [L3] Preoperative multifidus fatty infiltration was a good predictor for assessing improvement of patients' functional status. (10.1186/s13018-020-01751-1)
  • [L3] Preoperative management of modifiable risk factors may decrease length of inpatient stay, rates of disposition to non-home facilities, and total cost of care. (10.5435/jaaos-d-20-00294)
  • [L4] Spinal fusion resulted in durable radiographic correction and sustained improvements in caregiver-reported quality of life over a minimum of 5 years. (10.2106/jbjs.25.00186)
  • [L2] We developed two prognostic models containing partially different predictors, with acceptable performance for predicting (non-)recovery in patients with acute LBP, which was better than current practice. (10.1186/s12891-022-05718-7)
  • [L3] The combination of normal sitting radiograph (N) and supine sagittal MR image (sMR) has a significant advantage in identifying segmental instability. (10.1186/s12891-022-05761-4)
  • [L2] Overall bone metabolism of the operated intervertebral disc space at six weeks had the highest diagnostic accuracy for predicting the fusion status at one year. (10.1186/s13018-025-05814-z)
  • [L4] Early monitoring of these predictors should therefore be conducted in every spine centre. (10.1186/s12891-019-2918-0)
  • [L4] Any conclusion regarding comparison is limited due to the dearth of non-operative management studies and the high risk of bias. (10.1136/jisakos-2016-000105)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L2] High-quality studies targeting non-surgical treatment as an evidence-based alternative to surgical interventions for conditions related to excessive anterior pelvic tilt are warranted. (10.1302/2058-5241.5.190017)
  • [L4] Muscle weakness was associated with a history and risk of falling. (10.1186/s12891-019-2655-4)
  • [L4] Despite having subclinical alterations in gait, asymptomatic pelvic ring injured patients show minimal, if any, evidence of impaired functional outcome following successful reduction of a posterior pelvic disruption treated by CRPSF. (10.1186/s13018-015-0190-z)
  • [L2] These tests are simple to perform, reliable, and safe, and are recommended for use by physical therapists to assess suspected patients without immediate X-ray assessment. (10.1186/s12891-021-04854-w)
  • [L4] Elbow stiffness is a challenging problem with no ideal management solution; however, functional improvements can be achieved with both nonsurgical and surgical strategies, and recent advancements in biology and pathology may lead to future breakthroughs in prevention and treatment. (10.1016/j.jhsa.2013.06.007)
  • [L3] Poor physical functioning may lead to functional dependence, accelerated bone loss, and increased risk for falls, injuries, and fractures. (10.1186/s12891-017-1531-3)
  • [L2] Surgery in patients who had Duchenne muscular dystrophy with scoliosis improved function and decreased the rate of deterioration of forced vital capacity compared with patients treated conservatively. (10.2106/jbjs.m.00777)
  • [L4] Primary RSA provides good early functional results, reliable pain control, and excellent restoration of an independent life style in elderly patients. (10.1016/j.jse.2017.01.021)
  • [L4] These clinically important outcome values can assist clinicians and researchers with interpreting patients' clinical change during nonoperative treatment for nonarthritic hip-related pain. (10.1177/03635465251325466)
  • [L1] However, the mean improvement in Cobb angle was less than 5 degrees, suggesting that the clinical significance of these changes may be limited. (10.1186/s12891-025-09309-0)
  • [L3] Baseline biopsychosocial characteristics influence trajectories and prognosis in a cumulative, dose-dependent manner. (10.1186/s12891-025-09365-6)
  • [L4] Patients with a preoperative duration of symptomatic medial knee overload/arthritis of two years or greater do not experience inferior PRO or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up. (10.1016/j.jisako.2022.03.003)
  • [L1] It can be completed quickly and used in conjunction with patient-based measures of shoulder outcome to define patient populations for cohort studies, and to assess activity level as a prognostic factor in patients with shoulder disorders. (10.1097/01.blo.0000173255.85016.1f)

See Also

References

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[2] A functional outcome prediction model of acute traumatic spinal cord injury based on extreme gradient boost. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03343-7

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[4] Pre-operative functional status as a predictor of morbidity and mortality after elective cervical spine surgery. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b6.bjj-2016-1149.r1

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[30] Performance in dynamic movement tasks and occurrence of low back pain in youth floorball and basketball players. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03376-1

[31] Walking ability during daily life in patients with osteoarthritis of the knee or the hip and lumbar spinal stenosis: a cross sectional study. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-233

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[33] Targeting self-efficacy more important than dysfunctional behavioral cognitions in patients with longstanding chronic low back pain; a longitudinal study. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04637-3

[34] Subgroups of lumbo-pelvic flexion kinematics are present in people with and without persistent low back pain. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2233-1

[35] Worse self-reported outcomes but no limitations in performance-based measures in patients with long-standing hip and groin pain compared with healthy controls. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4101-6

[36] The role of wearables in spinal posture analysis: a systematic review. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2430-6

[37] Sick leave patterns in common musculoskeletal disorders – a study of doctor prescribed sick leave. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-176

[38] Correlations Among Objectively Measured Impairment, Outcome Classification Systems, and Subjectively Perceived Disability After Flexor Tendon Repair. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.06.010

[39] Return to activity is a multi-faceted variable, not a discrete yes-no. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2024.07.005

[40] Dynamic spinal posture and pelvic position analysis using a rasterstereographic device. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01825-0

[41] The virtue of optimistic realism - expectation fulfillment predicts patient-rated global effectiveness of total hip arthroplasty. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04040-y

[42] Leg pain location and neurological signs relate to outcomes in primary care patients with low back pain. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1495-3

[43] An experimental study investigating the effect of pain relief from oral analgesia on lumbar range of motion, velocity, acceleration and movement irregularity. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-304

[44] Implanted Neuroprostheses for Restoration of Hand Function in Tetraplegic Patients. Journal of the American Academy of Orthopaedic Surgeons. 2004. DOI: 10.5435/00124635-200403000-00002

[45] The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2438-y

[46] Clinically acceptable agreement between the ViMove wireless motion sensor system and the Vicon motion capture system when measuring lumbar region inclination motion in the sagittal and coronal planes. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1489-1

[47] Editorial Commentary: Restrictions in Spinal Motion Result in Lower Outcome Scores After Hip Arthroscopy. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.04.004

[48] Intraoperative Classification System Yields Favorable Outcomes for Patients Treated Surgically for Greater Trochanteric Pain Syndrome. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.01.058

[49] Reliability of lumbar spinal palpation, range of motion, and determination of position. BMC Musculoskeletal Disorders. 2007. DOI: 10.1186/1471-2474-8-103

[50] Wearable technology mediated biofeedback to modulate spine motor control: a scoping review. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07867-3

[51] Mid‐term results of Autologous Matrix‐Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1042-3

[52] Photographic measurement of upper-body sitting posture of high school students: A reliability and validity study. BMC Musculoskeletal Disorders. 2008. DOI: 10.1186/1471-2474-9-113

[53] Kinematic analysis of work-related musculoskeletal loading of trunk among dentists in Germany. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1288-0

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[56] The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04863-9

[57] Associations between disc space narrowing, anterior osteophytes and disability in chronic mechanical low back pain: a cross sectional study. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1562-9

[58] Altered motor control patterns in whiplash and chronic neck pain. BMC Musculoskeletal Disorders. 2008. DOI: 10.1186/1471-2474-9-90

[59] Patients with severe low back pain exhibit a low level of physical activity before lumbar fusion surgery: a cross-sectional study. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2274-5

[60] The quality of evidence of psychometric properties of three-dimensional spinal posture-measuring instruments. BMC Musculoskeletal Disorders. 2011. DOI: 10.1186/1471-2474-12-93

[61] Tendon transfer for treatment of internal rotation contracture of the shoulder in brachial plexus birth palsy. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412451401

[62] The association between disability and physical performance, pain intensity, and pain-related anxiety in patients after lumbar decompression surgery: a cross-sectional study. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04462-5

[63] The effect of paraspinal muscle on functional status and recovery in patients with lumbar spinal stenosis. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01751-1

[64] Discharge Destination After Shoulder Arthroplasty: An Analysis of Discharge Outcomes, Placement Risk Factors, and Recent Trends. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-20-00294

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[67] Radiographic analysis of dynamic lumbar motion during the five-repetition sit-to-stand test in degenerative lumbar spondylolisthesis. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05761-4

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[69] Psychological factors outmatched morphological markers in predicting limitations in activities of daily living and participation in patients with lumbar stenosis. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2918-0

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[73] Abdominal trunk muscle weakness and its association with chronic low back pain and risk of falling in older women. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2655-4

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b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.