Cook Ch. 10

Question 1

What are the 3 categorization processes during initial diagnostic triage?

Answer 1

1. Identification of nerve root-related problems
2. Identification of disorders that represent serious pathology
3. Identification of patients who fall under the classification heading of nonspecific low back pain.

Question 2

True/False: Assessment of nerve root-related problems requires the inability to rule in low back-related leg pain by using a SLR or slump test, and ruling out using specific tests such as those associated with hard neurological findings.

Answer 2

False: Assessment of nerve root-related problems requires the inability to rule OUT low back-related leg pain by using a SLR or slump test, and ruling IN using specific tests such as those associated with hard neurological findings.

Question 3

What percent of LBP is usually malignant cancer?

Answer 3

less than 1%

Question 4

What is the most diagnostic combination of red flags used to identify malignancy (4 of them)?
sensitivity and specificity of this cluster?

Answer 4

age more than 50
Hx of cancer
unexplained weight loss
failure of conservative care
sensitivity: 100%
specificity: 60%

Question 5

What is the most diagnostic combination of red flags used to identify ankylosing spondylitis (4 of them)?
sensitivity and specificity of this cluster?

Answer 5

age more than 40
early/slow onset
long term discomfort (more than 3 months)
morning stiffness
improvement of discomfort with exercise
sensitivity: 23%
specificity: 82%

Question 6

What is the main red flag for cauda equina syndrome?

sensitivity/specificity?

Answer 6

urinary retention

sensitivity: 90%
specificity: 95%

Question 7

What are the 3 classification index strategies used to categorize homegenous low back conditions?

Answer 7

1. Status index (Uses diagnoses designed to discriminate among faulty pathological tissue. groups based on suspected pain generators.)
2. Prognostic index (obtained from statistical analysis of preexisting data and are retrospective in nature. Classify with like-type outcomes.)
3. Patient response-based models (provide clinicians with potential exercise and treatment selctions based on the patient’s response to movements during an examination.)

Question 8

The patient-response model is further divided into 3 categories like:

Answer 8

provocation
reproduction
reduction

Question 9

True/False: The MDT method allows for modification of classification of disorders based on follow-up-findings

Answer 9

True

Question 10

What type of disorders does the MDT classification NOT identify

Answer 10

spine instability or sinister pathologies (tumors, fx’s)

Question 11

What are the 3 categories of serious specific low back diseases?

Answer 11

Nonmechanical spine disorders (neoplasia, infection, seronegative spondyloarthritides)
Visceral disease (pelvic, renal, aortic aneurysm, GI)
Miscellaneous (Paget's, Parathyroid disease, hemoglobinpathies)

Question 12

What is the primary pain generator in the lumbar spine?

Answer 12

lumbar intervertebral disc

Question 13

True/False: Peripheralization is associated with positive outcomes and a reduced tendency for disability.

Answer 13

False. CENTRALIZATION is associated with positive outcomes and a reduced tendency for disability.

Question 14

What is the sensitivity and specificity of centralizing behavior for the presence of disc syndrome?

Answer 14

95% sensitive

52% specific

Question 15

True/False: There is a large correlation between total ROM and functional assessment scores.

Answer 15

False. There is a POOR correlation between total ROM and functional assessment scores.

Question 16

What are repeated motions useful for in examination of a LBP patient?

Answer 16

determining if the patient is a centralizer versus a peripheralizer and will contribute to predicting the likelihood of a positive long-term outcome.

Question 17

What are sustained movements or postures useful for in examination of a LBP patient?

Answer 17

preferences in directions of sustained holds or demonstrating reduction of pain once a segment is stretched or tension is released.

Question 18

True/False: PROM is necessary to elicit the concordant sign of the patient.

Answer 18

False. AROM is necessary to elicit the concordant sign of the patient.

Question 19

What is the most useful information collected during PROM screening?

Answer 19

comparison between active physiological motions.

Question 20

What is the most useful purpose of using passive accessory assessment?

Answer 20

When pain provocation is the goal, NOT when “stiffness-only” assessment is the goal.

Question 21

Why is palpation generally not useful for implicating selected tissue in the lumbar spine?

Answer 21

Because of convergence where different structures are innervated by the same systems and the brain is unable to ascertain where and what structure those afferent messages were from.

Question 22

What are the 4 divisions of the Treatment-based classification?

Answer 22

stabilization group
mobilization group
specific exercise group
traction group

Question 23

What patients would be included in the specific exercise group?

Answer 23

Those that demonstrate:

• postural preferences
• centralization behavior with selected movements
• reduction of pain during active and passive techniques

Question 24

What patients would be included in the mobilization group?

Answer 24

Those that demonstrate:

• local, unilateral low back pain
• sacroiliac joint-related pain

Question 25

What patients would be included in the stabilization/immobilization group?

Answer 25

Those that demonstrate: | -frequent bouts of similar back pain and could be associated with instability.

Question 26

What patients would be included in the traction group?

Answer 26

Those that demonstrate: - signs & symptoms of nerve root compression - no improvement with lumbar movements - potential lateral shift that is unimproved with lateral translations