JUDGMENTS OF CENTRALIZATION DURING MOVEMENT TESTING
ICF category	Measurement of impairment of body function – pain in back; pain in lower limb; and mobility of several joints
Description	Clinician judges the behavior of symptoms in response to movement testing to assess whether centralization or peripheralization occurs. Judgments of centralization requires that an accurate assessment of the patient’s baseline location of symptoms is made followed by the precise application of active or passive movements and the associated assessments of any changes in the patient’s baseline location of symptoms in response to the movements. Centralization occurs when the location of the patient’s symptoms, such as pain or paresthesias, is perceived by the patient to be in a more proximal location in response to single and repeated movements or sustained positions. Peripheralization occurs when the location of the patient’s symptoms is perceived in a more distal location, such as the calf or foot, response to single and repeated movements or sustained positions.
Measurement method	Patient is asked to flex and extend in the sagittal plane, or laterally shift the pelvis and trunk in the frontal plane, in standing, supine and prone with single and repeated movements in a systematic fashion. When appropriate, the clinician can manually guide the movements of the patient and apply passive overpressures to the movements. Judgments are made with regard to which movement, if any, produces centralization of the patient’s symptoms.
Nature of variable	Categorical
Units of measurement	Present/absent
Measurement properties	Kappa are reported to be 0.70 to 0.90 for novice and experienced physical therapists106, 175
Instrument variations	Techniques to improve the precision of these judgments have been described, including strategies to discriminate between centralization and directional preference responses.309 However, the practicality of using these strategies has not been demonstrated.