LBP CPG Flashcards
According to the CPG, what should the focus of treatment be on?
Preventing reoccurence - transitioning to CLBP
According to the CPG, which gender is more often affected with LBP?
Women > men
What is one single factor which contribute to inc prevalence and worse outcome?
Lower educational standards - has inc prevalence, longer episode duration, worse outcome
Is there an association with a higher physically demanding job and LBP?
Yes - higher prevalence
What are four factors associated with sciatica?
1) Cardiovascular HTN
2) smoking
3) overweight
4) obesity
What type of evidence exists regarding trunk muscle strength and mobility and their roles in LBP?
Inconclusive at best
Which seems to play a greater role in development of LBP: psychosocial or physical factors
Psychosocial - fear, distress/depression, fear avoidance, expectation of recovery, job related satisfaction
Can a pathoanatomical cause be found for most cases of LBP?
No - approx 47% with sxs have abnormality identified
32% of asymptomatic subjects had abnormal lumbar spines
What phase of LBP is occurring with sxs lasting between 2-3 months?
Subacute
What are 3 prognostic indicators for reoccurrence?
1) hx of previous episodes
2) excessive spinal mobility
3) excessive mobility in other joints
What are 5 prognostic indicators for progression to CLBP?
1) presence of sxs below knees
2) psychological distress/depression
3) fear of pain, movement and reinjury - low expectations of recovery
4) high pain intensity
5) passive coping style
Are acute or chronic cases of LBP which are matched with treatment based classification group more successful?
Acute have better outcomes
Does routine imaging seem to result in increased clinical benefit for pts with LBP?
No - seems to contribute to more fear and may lead to harm
Henschke’s 5 factors for identifying spinal fractures:
1) age >50
2) female gender
3) hx of major trauma
4) pain and tenderness
5) co-occurring distracting/painful injury
Henschke’s factor lead to the diagnostic predictive rule for fractures: (4 items)
1) female
2) > 70 years old
3) significant trauma
4) prolong use corticosteroids
True or false: altered patterns of firing, altered cross sectional areas of multifidus and severe fat infiltration has been shown to be associated with LBP
True - muscles of the trunk fire sooner, longer
multifidi are not as active and have high fat infiltration (odds ratio for fat infiltration 9.2)
Factors associated with back-related tumor: (6)
1) Constant pain, no affect from position/activity - worse with WB and at night
2) Age > 50
3) Hx of cancer ** good Sp/+LR
4) Failure to improve in 30 days with conservative intervention (Sn 0.29 / Sp 0.90 - +LR 3 / -LR 0.79)
5) unexplained weight loss
6) no relief with bed rest ** good Sn/-LR
Factors with cauda equina syndrome (4)
1) urine retention *** good Sp/+LR and Sn/-LR
2) fecal incontinence
3) saddle anesthesia
4) sensory / motor deficits in feet (L4,5 - S1)
Factors with back related infection: (5)
1) recent infection (UTI, cellulitis) or IV drug use/abuse
2) concurrent immunosuppressive disorder
3) deep constant ache, inc with WB
4) fever, malaise, swelling
5) spine rigidity - limited accessory motion testing
Factors with abdominal aneurysm: (7)
1) hx of PVD, CAD
2) hx of smoking
3) family hx
4) age > 70
5) non-caucasian
6) female
7) sxs not related to movement stresses / somatic LBP
What is the MCD for the ODI?
10 points out of 100 or 30% from baseline
What is the MCD for the Roland Morris Disability Questionnaire?
5 points of 24 or 30% from baseline
What is the MCD for VAS?
15 on 100 mm scale and 2 on 10 point scale
How is lumbar ROM measured?
Inclinometers placed at the TL junction and on the sacrum
Has validity been established regarding segmental motion assessment in prone?
Yes - correlated with radiographic evidence of lumbar instability, as well as response to treatment
Are Kappa values high or low for centralization movements during movement testing?
Kappa is 0.70-0.90 which correlates to substantial agreement beyond chance
Does the Prone Instability test have good diagnostic use?
No, better as part of cluster - +LR 1.7 / -LR 0.48
What is another name for aberrant movement during motion testing?
Gowers sign - painful arc with flexion or return from flexion, instability catch, reversal of lumbopelvic rhythm all are examples of aberrant movement
The SLR has moderate reliability in identifying patients with radiating pain or sxs below what angle?
45 deg - Kappa 0.43
What are examples of cognitive assessments with LBP that are useful in determining psychosocial influence? (4 measures)
1) FABQ
2) Pain catastrophizing scale
3) OMPQ
4) STarT Back screening tool
According to Gellhorn, those receiving early intervention at this cutoff time frame were less likely to progress to needing lumbosacral injection.
4 weeks - compared to 3 months
Also decreased number of visits
Is manual therapy (thrust/non-thrust) done in isolation or in comprehensive approach?
More effective as a component of comprehensive plan
What are the Flynn predictors of rapid treatment success with thrust manipulation (5):
1) Duration <16 days
2) No sxs distal to knee
3) lumbar hypomobility
4) one hip with >35deg IR
5) FABQ-W < 19
What two Flynn factors were established by Childs as even more pragmatic with LBP to benefit from thrust manipulation:
1) sxs less than 16 days
2) no sxs distal to knee
(+LR 7.2)
Fritz established those with hypomobility in the lumbar spine benefit more from combination of exercise and what?
Thrust manipulation - in absence of contraindications, consider use of manipulation
Cecchi found better long term outcomes and reduction in disability in subacute/chronic low back pain in which intervention when comparing back school, manipulation or individualized PT?
Manipulation - less drug usage, less reoccurrences
True or false; thrust and non-thrust manipulation/mobilization betters outcome with those diagnosed with spinal stenosis
True - Whitman, Murphy, Reiman all had positive response to mob/manip for lumbopelvic region with exercise
What is the stabilization CPR: (4 factors)
1) age <40
2) positive PIT test
3) presence of aberrant movement with motion testing
4) SLR > 91 deg
Not yet validated though!
According to Macedo/systematic review, do motor control exercises (in isolation or combined) effectively decrease LBP?
Yes - but not superior to manual therapy or other exercise interventions
RCT of Rasmussen-Barr: comparing graded exercise vs. walking program - better outcomes associated with which intervention?
Graded exercise - stabilization exercise improves perception of disability, health
RCT Choi: moderate quality evidence that 2 factors were reduced with reoccurence?
1) number of reoccurences was reduced
2) discharge HEP can prevent reoccurence
When matched to repeated movement which alleviates pain, how much more likely is success for the patient?
7.8 x more likely to have positive outcome
Does the McKenzie method tend to have better short-term or long-term outcomes?
Better short-term
Flexion-based or Williams flexion exercises should be coupled with what to improve success with treatment?
Manual therapy, strengthening exercise, nerve mobilizations, progressive walking
RTC Cleland: pts with sxs distal to buttocks with reproduction of sxs during Slump test and no directional preference - better outcomes with manual therapy (nonthrust) to lumbar spine with exercise or slump-stretching?
Slump-stretching - less perceived pain, distal sxs
What two factors identify a subgroup of patients that may benefit from intermittent traction for the lumbar spine?
1) signs of nerve root compression with peripheralization
2) positive crossed SLR
What position is intermittent traction performed in for the identified subgroup?
Prone
Is there evidence to avoid using traction to treat patients with acute/subacute nonradicular LBP or chronic LBP?
Yes - moderate evidence that it should NOT be used
What six areas should patient education focus on with low back pain?
1) the spine is strong
2) pain science - pain perception
3) overall favorable prognosis
4) active pain coping strategies
5) resume ADLs/work early
6) improving activity levels, not just pain
In the case of low back pain, is low intensity, moderate intensity or high intensity exercise best?
Moderate to high intensity
In chronic low back pain, central sensitization has been shown to have deficits in aerobic fitness and tissue deconditioning. What type of aerobic fitness training should be prescribed?
Progressive, low intensity, submaximal fitness/endurance activities
