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Rehab Measures: Beiring-Sorensen Test

Link to instrument

http://www.ncbi.nlm.nih.gov/pubmed/16461206 

Title of Assessment

Beiring-Sorensen Test 

Acronym

Instrument Reviewer(s)

Caitlin 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

Summary Date

10/29/2015 

Purpose

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.

Description

  • The patient lies prone on the examining table with the upper edge of the iliac crests in alignment with the edge of the table.
  • The lower body is fixed to the table by three straps around the pelvis, knees, and ankles, respectively. With the arms folded across the chest, the patient isometrically maintains the upper body in a horizontal position while time is recorded.
  • In patients who experience no difficulty in holding the position, the test is stopped after 240 s.
  • Biering-Sørensen reports that a position-holding time less than 176 seconds predicts low back pain during the next year in males, whereas a time greater than 198 s predicts absence of low back pain.
  • It is important to highlight that the test currently has no predictive validity in females.

Area of Assessment

Pain; Strength 

Body Part

Back 

ICF Domain

Body Structure; Body Function 

Domain

Motor 

Assessment Type

Performance Measure 

Length of Test

05 Minutes or Less 

Time to Administer

Less than 10 minutes: this includes the setup, explanation and demonstration of proper completion, and the actual time to perform the test (240s maximum).

Number of Items

Equipment Required

Examination Table; 2-5 Straps or Roman Chair; Stopwatch

Training Required

No formal training required. Reading an Article/Manual

Type of training required

Reading an Article/Manual 

Cost

Free 

Actual Cost

Assuming test is performed in a clinic with examination tables and straps, there are no additional costs.

Age Range

Child: 6-12 years; Adolescent: 13-17 years; Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Pain 

Populations Tested

 

Standard Error of Measurement (SEM)

Current, Previous, and No History of Lower Back Pain (Latimer et al., 1999)

  • All subjects: SEM= 15.6s
  • Current NSLBP: SEM= 11.6s
  • Previous NSLBP: SEM= 17.5s
  • Asymptomatic LBP: SEM= 17.4s
  • Physically inactive adults: SEM= 17.5s
  • Physically active adults: SEM= 15.2s
Young, Healthy Subjects (McGill et al., 1999)
  • Males: SEM= 7.21s
  • Females: SEM= 8.49s

Pain Free and Nonspecific Lower Back Pain (Simmonds et, al., 1998)

  • Lower Back Pain: SEM =8.7s
  • Healthy: SEM= 17.6s

Minimal Detectable Change (MDC)

Current, Previous, and No History of Lower Back Pain (Latimer et al., 1999; Calculated from the SEMs given in the article)

  •  All subjects: MDC= 43.2s
  • Current NSLBP: MDC= 32.1
  • Previous NSLBP: MDC= 48.5s
  • Asymptomatic LBP: MDC= 48.2
  • Physically inactive adults: MDC= 48.5
  • Physically active adults: MDC= 42.1

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

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

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

Test-retest Reliability

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

Interrater/Intrarater Reliability

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

  • Good intertester reliability and discriminative power in adolescents with and those without LBP

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

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.

Construct Validity (Convergent/Discriminant)

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

  • Statistically significant difference in performance of LBP patients and healthy controls (ES = 1.05, 1.14, p=0.0001)

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Simmonds et. al, 1998

  • Minimum 0.49 seconds, all patients at least on the scale so suggests no floor effect

Demoulin et al., 2006

  • Theoretically, no ceiling effect because patients hold as long as possible but 4 minutes used as maximum in many studies

Responsiveness

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)

Professional Association Recommendations

None Reported

Considerations

  • 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).

Bibliography

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.

Year published

1984 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 10/29/2015 8:33 AM  by Jason Raad 
Last modified at 2/16/2016 8:38 AM  by Jason Raad