Schober Test: Difference between revisions
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== Purpose ==
== Purpose ==


The purpose of the Schober test is to reflect the lumbar ROM during flexion<ref name="Rez">Rezvani A, Ergin O., Karacan I., Validity and reliability of the Metric Measurements in the Assessment of Lumbar Spine Motion in patients with Ankylosing Spondylitis., 2012, Lippincott Williams &amp; Wilkins, SPINE vol 37, Number 19, pp E1189-E1196 (level of Evidence: 1B)</ref>. The measurement of this test is not only useful for screening the status of [[Ankylosing Spondylitis|ankylosing spondylitis]] disease but also useful for the determination of progression and therapeutic effects of ankylosing spondylitis as well as other pathologic conditions associated with low back pain<ref>Yen YR, Luo JF, Liu ML, Lu FJ, Wang SR. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530222/ The anthropometric measurement of schober’s test in normal taiwanese population.] BioMed research international. 2015;2015.</ref>.
Schober’s test is classically used to determine if there is a decrease in lumbar spine range of motion (flexion), most commonly as a result of ankylosing spondylitis.<ref name="Rez">Rezvani A, Ergin O., Karacan I., Validity and reliability of the Metric Measurements in the Assessment of Lumbar Spine Motion in patients with Ankylosing Spondylitis., 2012, Lippincott Williams &amp; Wilkins, SPINE vol 37, Number 19, pp E1189-E1196 (level of Evidence: 1B)</ref>.  
 
The measurement of this test is useful for  
* Screening the status of [[Ankylosing Spondylitis|ankylosing spondylitis]] disease  
* Determination of progression and therapeutic effects of ankylosing spondylitis and other pathologic conditions associated with low back pain<ref>Yen YR, Luo JF, Liu ML, Lu FJ, Wang SR. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530222/ The anthropometric measurement of schober’s test in normal taiwanese population.] BioMed research international. 2015;2015.</ref>.


== Technique ==
== Technique ==
Schöber Test
* Patient is standing, examiner marks the L5 spinous process by drawing a horizontal line across the patients back.
* A second line is marked 10 cm above the first line.
* Patient is then instructed to flex forward as if attempting to touch his/her toes, examiner remeasures distance between two lines with patient fully flexed.
* The difference between the measurements in erect and flexion positions indicates the outcome of the lumbar flexion <ref name="Rez" />.
Modified Schober Test (eliminates the errors in identification of lumbosacral junction and makes sure that the entire lumbar spine was included<ref name="Rez" /><ref>Tousignant M, Poulin L, Marchand S, Viau A, Place C. [https://www.ncbi.nlm.nih.gov/pubmed/16019864 The Modified–Modified Schober Test for range of motion assessment of lumbar flexion in patients with low back pain: A study of criterion validity, intra-and inter-rater reliability and minimum metrically detectable change.] Disability and rehabilitation. 2005 May 20;27(10):553-9.</ref>
* Patient is standing, examiner marks both posterior superior iliac spine (PSIS) and then draws a horizontal line at the centre of both marks
* A second line is marked 5 cm bellow the first line.
* A third line is marked 10 cm above the first line.
* Patient is then instructed to flex forward as if attempting to touch his/her toes, examiner remeasures distance between the top and bottom line.. <ref name="Rez" />.


#Original Schöber Test<br>The patient is standing with his back towards the examiner. The examiner determines the location of the lumbosacral junction and marks it by drawing a horizontal line. A second line is marked 10 cm above the first line. The difference between the measurements in erect and flexion positions indicates the outcome of the lumbar flexion <ref name="Rez" />.
=== Interpretation ===
#Modified Schöber Index is also called short Schöber test <ref name="p2">G.Lilius, Laasonen EM, Myllynen P, Harilainen A, Gronlund G,  Lumbar facet joint syndrome, Helsinki university hospital, vol 71B, No. 4, August 1989, 681-684 (Level of evidence: 1B)</ref>.<br>The patient is standing with his back towards the examiner. The examiner determines the location of the lumbosacral junction by pressing the location of the dimples of Venus. The intersection of the top of the dimples of Venus is marked by drawing a horizontal line. This line acts as the landmark. The second line is marked 10 cm above the first and the third is marked 5 cm below the first line. The difference between the measurements in erect and flexion positions indicates the outcome of the lumbar flexion. <ref name="Rez" />.
For both versions of the test, an increase of less than 5cm is a positive test and may indicate ankylosing spondylitis.
{{#ev:youtube|B9RaFB5BwrQ}}<ref>BJC Health Modified Schober's Test for Ankylosing Spondylitis. Available fromhttps://www.youtube.com/watch?v=B9RaFB5BwrQ</ref>
 


3.Modified-modified Schöber Test<br>Modified Modified Schober  Test  (MMST) is a modification of the Modified Schober Test (MST) by Van Adrichen and Van der Korst (1973)<ref>Tousignant M, Poulin L, Marchand S, Viau A, Place C. [https://www.ncbi.nlm.nih.gov/pubmed/16019864 The Modified–Modified Schober Test for range of motion assessment of lumbar flexion in patients with low back pain: A study of criterion validity, intra-and inter-rater reliability and minimum metrically detectable change.] Disability and rehabilitation. 2005 May 20;27(10):553-9.</ref>. The patient is standing with his back towards the examiner. The examiner locates the inferior margin of the PSIS with the thumbs and then marks the intersections of the SIPS by drawing a horizontal line. The second line is drawn 15 cm above the midpoint of the first horizontal line. The difference between the measurements in erect and flexion positions indicates the outcome of the lumbar flexion<ref name="Rez" />. It eliminates the errors in identification of lumbosacral junction and makes sure that the entire lumbar spine was included.
Positive Schober’s Test


Less then 5cm increase in length with forward flexion : Decreased lumbar spine range of motion, ankylosing spondylitis


== Evidence ==
=== Clinical Notes ===
This test is almost exclusively associated with Ankylosing Spondylitis, but may also be positive due to a decrease in lumbar range of motion due to pain or congenital anomalies or segmental fusion<ref>Medisavy [https://medisavvy.com/schobers-test/ Schobers Test] Available from:https://medisavvy.com/schobers-test/ (last accessed 30.5.2020)</ref>.{{#ev:youtube|B9RaFB5BwrQ}}<ref>BJC Health Modified Schober's Test for Ankylosing Spondylitis. Available fromhttps://www.youtube.com/watch?v=B9RaFB5BwrQ</ref>


=== Evidence ===
#Original Schöber Test<br>The validity against radiographs was according to Macrae. strong (r=0.90), according to Rahali-Khachlouf. moderate (r=0.68).<br>The interclass (r=0.90) and intraclass (r=0.96) reliability was found to be excellent<ref name="Rez" />.
#Original Schöber Test<br>The validity against radiographs was according to Macrae. strong (r=0.90), according to Rahali-Khachlouf. moderate (r=0.68).<br>The interclass (r=0.90) and intraclass (r=0.96) reliability was found to be excellent<ref name="Rez" />.
#Modified Schöber Index<br>The validity against radiographs was according to Macrae. strong (r=0.97), according to Rahali-Khachlouf. moderate (r=0.59).<br>The interclass (r=0.92) and intraclass (r=0.96) reliability were found to be excellent<ref name="p3">M Tousignant, Poulin L, Marchand S, , the modified-modified schober test for range of motion assessment of lumbar flexion in patients with low back pain: a study of criterion validity, intra- and inter-rater reliability and minimum metrically detectable change, disability and rehabilitation, 2005, VOL.27, NO.10, Pages 553-559 (Level of evidence: 4)</ref>.
#Modified Schöber Index<br>The validity against radiographs was according to Macrae. strong (r=0.97), according to Rahali-Khachlouf. moderate (r=0.59).<br>The interclass (r=0.92) and intraclass (r=0.96) reliability were found to be excellent<ref name="p3">M Tousignant, Poulin L, Marchand S, , the modified-modified schober test for range of motion assessment of lumbar flexion in patients with low back pain: a study of criterion validity, intra- and inter-rater reliability and minimum metrically detectable change, disability and rehabilitation, 2005, VOL.27, NO.10, Pages 553-559 (Level of evidence: 4)</ref>.

Revision as of 07:34, 30 April 2020

Original Editor - Shauni Van Overstraeten Top Contributors - Vidya Acharya, Kim Jackson, Jolien Wauters, Shauni Van Overstraeten, WikiSysop, Lucinda hampton, Kai A. Sigel, Chelsea Mclene and Anne Dixie Lim

Purpose[edit | edit source]

Schober’s test is classically used to determine if there is a decrease in lumbar spine range of motion (flexion), most commonly as a result of ankylosing spondylitis.[1].

The measurement of this test is useful for

  • Screening the status of ankylosing spondylitis disease
  • Determination of progression and therapeutic effects of ankylosing spondylitis and other pathologic conditions associated with low back pain[2].

Technique[edit | edit source]

Schöber Test

  • Patient is standing, examiner marks the L5 spinous process by drawing a horizontal line across the patients back.
  • A second line is marked 10 cm above the first line.
  • Patient is then instructed to flex forward as if attempting to touch his/her toes, examiner remeasures distance between two lines with patient fully flexed.
  • The difference between the measurements in erect and flexion positions indicates the outcome of the lumbar flexion [1].

Modified Schober Test (eliminates the errors in identification of lumbosacral junction and makes sure that the entire lumbar spine was included[1][3]

  • Patient is standing, examiner marks both posterior superior iliac spine (PSIS) and then draws a horizontal line at the centre of both marks
  • A second line is marked 5 cm bellow the first line.
  • A third line is marked 10 cm above the first line.
  • Patient is then instructed to flex forward as if attempting to touch his/her toes, examiner remeasures distance between the top and bottom line.. [1].

Interpretation[edit | edit source]

For both versions of the test, an increase of less than 5cm is a positive test and may indicate ankylosing spondylitis.

Positive Schober’s Test

Less then 5cm increase in length with forward flexion : Decreased lumbar spine range of motion, ankylosing spondylitis

Clinical Notes[edit | edit source]

This test is almost exclusively associated with Ankylosing Spondylitis, but may also be positive due to a decrease in lumbar range of motion due to pain or congenital anomalies or segmental fusion[4].

[5]

Evidence[edit | edit source]

  1. Original Schöber Test
    The validity against radiographs was according to Macrae. strong (r=0.90), according to Rahali-Khachlouf. moderate (r=0.68).
    The interclass (r=0.90) and intraclass (r=0.96) reliability was found to be excellent[1].
  2. Modified Schöber Index
    The validity against radiographs was according to Macrae. strong (r=0.97), according to Rahali-Khachlouf. moderate (r=0.59).
    The interclass (r=0.92) and intraclass (r=0.96) reliability were found to be excellent[6].
  3. Modified-modified Schöber Test
    The validity of the modified-modified Schober test is moderate (r=0.67) with an excellent interclass (r=0.91) and intraclass (r=95) reliability[1].


[7]


References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Rezvani A, Ergin O., Karacan I., Validity and reliability of the Metric Measurements in the Assessment of Lumbar Spine Motion in patients with Ankylosing Spondylitis., 2012, Lippincott Williams & Wilkins, SPINE vol 37, Number 19, pp E1189-E1196 (level of Evidence: 1B)
  2. ↑ Yen YR, Luo JF, Liu ML, Lu FJ, Wang SR. The anthropometric measurement of schober’s test in normal taiwanese population. BioMed research international. 2015;2015.
  3. ↑ Tousignant M, Poulin L, Marchand S, Viau A, Place C. The Modified–Modified Schober Test for range of motion assessment of lumbar flexion in patients with low back pain: A study of criterion validity, intra-and inter-rater reliability and minimum metrically detectable change. Disability and rehabilitation. 2005 May 20;27(10):553-9.
  4. ↑ Medisavy Schobers Test Available from:https://medisavvy.com/schobers-test/ (last accessed 30.5.2020)
  5. ↑ BJC Health Modified Schober's Test for Ankylosing Spondylitis. Available fromhttps://www.youtube.com/watch?v=B9RaFB5BwrQ
  6. ↑ M Tousignant, Poulin L, Marchand S, , the modified-modified schober test for range of motion assessment of lumbar flexion in patients with low back pain: a study of criterion validity, intra- and inter-rater reliability and minimum metrically detectable change, disability and rehabilitation, 2005, VOL.27, NO.10, Pages 553-559 (Level of evidence: 4)
  7. ↑ Schober Test for Lumbar Spine Flexion. Available from: https://www.youtube.com/watch?v=eYOUA9asDu8
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