Clinical Practice Guidelines Flashcards
Purpose of clinical guidelines
- describe EB PT practice, including diagnosis, prognosis, intervention, and assessment of outcomes
- describe literature and make recommendations related to tx matched to LBP subgroup categories
Goals of patient management
Improve ability to perform ADLs
Reduce disability
Advance in rehab
Physical impairment measures
Lumbar ROM Segmental mobility assess (PIVMs) Pain provocation with segmental mobility Judgment of centralization during movement testing (repeated flex/ext) Prone instability test Judgment of presence of aberrant movement SLR Slump test Trunk muscle power and endurance Passive hip IR, ER, Flex, Ext
Mental Impairment Measures
Fear avoidance beliefs questionairre
Pain catastrophizing scale
Orebro musculoskeletal pain screening questionairre
Subgroups for targeted tx back screening tool
Interventions
Manual therapy Neurodynamic procedures Traction Education Trunk coordination, strengthening, endurance Directional preference/centralization Flexion exercises Progressive endurance exercises
Coordinated Strength Endurance
Also described as - motor control exercises - transversus abdominis training - lumbar multifidus training - dynamic lumbar stabilization exercises Commonly prescribed for patients with a diagnosis of spinal instability
Coordination strength endurance - evidence shows
stabilization exercises are not only beneficial to people with movement coordination impairment but also with LBP and mobility deficit and post-surgical
Coordination Strength Endurance recommended for ICF categories:
LBP with mobility deficits
with movement coordination impairments
with referred lower extremity pain
Directional Preference/Centralization
Repeated movements to promote centralization, to reduce symptoms
Specific direction determined by response to repeated motion testing
Directional Preference/Centralization recommended for ICF categories:
LBP with referred LE pain
LBP with mobility deficit
Flexion-Based Exercise
Also called Williams Flexion Exercises
Classification:
- mostly older patients
- often with diagnosis of lumbar spinal stenosis
Theoretically opens or expands the area of the foraminal canals and central spinal canal to relieve mechanical nerve compression
Neurodynamic/Nerve Mobilization Exercises: ICF categories
LBP with radiating pain
Progressive Endurance
Progressive aerobic exercise: moderate to high evidence on patients with chronic LBP
To improve and maintain function
