THE CENTRALIZATION PHENOMENON - ITS USEFULNESS AS A PREDICTOR OF OUTCOME IN CONSERVATIVE TREATMENT OF CHRONIC LOW-BACK-PAIN (A PILOT-STUDY)

Study Design. Two-hundred-forty-three patients with chronic low back pain were studied in a prospective comparative survey to determine whether the ''centralization phenomenon'' was associated with outcome after an interdisciplinary work-hardening program. Objective. The hypothesis was that patients who demonstrated centralization during initial mechanical assessment would have better outcomes than noncentralizers. Summary of Background Data. Overall, subjects has decreased pain intensity ratings (mean 10%), increased lifting ability (6-8 kg), and a 59.2% return-to-work rate at a mean of 9.7 months follow-up. Methods. Patients were classified as either centralizers or noncentralizers, based on results of their initial assessment. Changes in pain rating, one-time maximal weights lifted, Oswestry scores, and return-to-work status were compared between groups. Results. The centralizers reported significant decreased in their maximum pain rating (centralizers, 16%; noncentralizers, 6%) and had a higher reutrn-to-work rate (centralizers, 68%; noncentralizers, 52%) than the noncentralizers. Conclusion. Centralization can help identify sub-groups within the population with chronic low back pain and could be a useful goal setting and case management tool in the rehabilitation of low back pain.