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OCS Cards > LBP CPG > Flashcards

LBP CPG Flashcards

1
Q

According to the CPG, what should the focus of treatment be on?

A

Preventing reoccurence - transitioning to CLBP

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2
Q

According to the CPG, which gender is more often affected with LBP?

A

Women > men

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3
Q

What is one single factor which contribute to inc prevalence and worse outcome?

A

Lower educational standards - has inc prevalence, longer episode duration, worse outcome

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4
Q

Is there an association with a higher physically demanding job and LBP?

A

Yes - higher prevalence

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5
Q

What are four factors associated with sciatica?

A

1) Cardiovascular HTN
2) smoking
3) overweight
4) obesity

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6
Q

What type of evidence exists regarding trunk muscle strength and mobility and their roles in LBP?

A

Inconclusive at best

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7
Q

Which seems to play a greater role in development of LBP: psychosocial or physical factors

A

Psychosocial - fear, distress/depression, fear avoidance, expectation of recovery, job related satisfaction

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8
Q

Can a pathoanatomical cause be found for most cases of LBP?

A

No - approx 47% with sxs have abnormality identified

32% of asymptomatic subjects had abnormal lumbar spines

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9
Q

What phase of LBP is occurring with sxs lasting between 2-3 months?

A

Subacute

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10
Q

What are 3 prognostic indicators for reoccurrence?

A

1) hx of previous episodes
2) excessive spinal mobility
3) excessive mobility in other joints

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11
Q

What are 5 prognostic indicators for progression to CLBP?

A

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

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12
Q

Are acute or chronic cases of LBP which are matched with treatment based classification group more successful?

A

Acute have better outcomes

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13
Q

Does routine imaging seem to result in increased clinical benefit for pts with LBP?

A

No - seems to contribute to more fear and may lead to harm

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14
Q

Henschke’s 5 factors for identifying spinal fractures:

A

1) age >50
2) female gender
3) hx of major trauma
4) pain and tenderness
5) co-occurring distracting/painful injury

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15
Q

Henschke’s factor lead to the diagnostic predictive rule for fractures: (4 items)

A

1) female
2) > 70 years old
3) significant trauma
4) prolong use corticosteroids

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16
Q

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

A

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)

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17
Q

Factors associated with back-related tumor: (6)

A

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

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18
Q

Factors with cauda equina syndrome (4)

A

1) urine retention *** good Sp/+LR and Sn/-LR
2) fecal incontinence
3) saddle anesthesia
4) sensory / motor deficits in feet (L4,5 - S1)

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19
Q

Factors with back related infection: (5)

A

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

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20
Q

Factors with abdominal aneurysm: (7)

A

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

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21
Q

What is the MCD for the ODI?

A

10 points out of 100 or 30% from baseline

22
Q

What is the MCD for the Roland Morris Disability Questionnaire?

A

5 points of 24 or 30% from baseline

23
Q

What is the MCD for VAS?

A

15 on 100 mm scale and 2 on 10 point scale

24
Q

How is lumbar ROM measured?

A

Inclinometers placed at the TL junction and on the sacrum

25
Q

Has validity been established regarding segmental motion assessment in prone?

A

Yes - correlated with radiographic evidence of lumbar instability, as well as response to treatment

26
Q

Are Kappa values high or low for centralization movements during movement testing?

A

Kappa is 0.70-0.90 which correlates to substantial agreement beyond chance

27
Q

Does the Prone Instability test have good diagnostic use?

A

No, better as part of cluster - +LR 1.7 / -LR 0.48

28
Q

What is another name for aberrant movement during motion testing?

A

Gowers sign - painful arc with flexion or return from flexion, instability catch, reversal of lumbopelvic rhythm all are examples of aberrant movement

29
Q

The SLR has moderate reliability in identifying patients with radiating pain or sxs below what angle?

A

45 deg - Kappa 0.43

30
Q

What are examples of cognitive assessments with LBP that are useful in determining psychosocial influence? (4 measures)

A

1) FABQ
2) Pain catastrophizing scale
3) OMPQ
4) STarT Back screening tool

31
Q

According to Gellhorn, those receiving early intervention at this cutoff time frame were less likely to progress to needing lumbosacral injection.

A

4 weeks - compared to 3 months

Also decreased number of visits

32
Q

Is manual therapy (thrust/non-thrust) done in isolation or in comprehensive approach?

A

More effective as a component of comprehensive plan

33
Q

What are the Flynn predictors of rapid treatment success with thrust manipulation (5):

A

1) Duration <16 days
2) No sxs distal to knee
3) lumbar hypomobility
4) one hip with >35deg IR
5) FABQ-W < 19

34
Q

What two Flynn factors were established by Childs as even more pragmatic with LBP to benefit from thrust manipulation:

A

1) sxs less than 16 days
2) no sxs distal to knee
(+LR 7.2)

35
Q

Fritz established those with hypomobility in the lumbar spine benefit more from combination of exercise and what?

A

Thrust manipulation - in absence of contraindications, consider use of manipulation

36
Q

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?

A

Manipulation - less drug usage, less reoccurrences

37
Q

True or false; thrust and non-thrust manipulation/mobilization betters outcome with those diagnosed with spinal stenosis

A

True - Whitman, Murphy, Reiman all had positive response to mob/manip for lumbopelvic region with exercise

38
Q

What is the stabilization CPR: (4 factors)

A

1) age <40
2) positive PIT test
3) presence of aberrant movement with motion testing
4) SLR > 91 deg
Not yet validated though!

39
Q

According to Macedo/systematic review, do motor control exercises (in isolation or combined) effectively decrease LBP?

A

Yes - but not superior to manual therapy or other exercise interventions

40
Q

RCT of Rasmussen-Barr: comparing graded exercise vs. walking program - better outcomes associated with which intervention?

A

Graded exercise - stabilization exercise improves perception of disability, health

41
Q

RCT Choi: moderate quality evidence that 2 factors were reduced with reoccurence?

A

1) number of reoccurences was reduced

2) discharge HEP can prevent reoccurence

42
Q

When matched to repeated movement which alleviates pain, how much more likely is success for the patient?

A

7.8 x more likely to have positive outcome

43
Q

Does the McKenzie method tend to have better short-term or long-term outcomes?

A

Better short-term

44
Q

Flexion-based or Williams flexion exercises should be coupled with what to improve success with treatment?

A

Manual therapy, strengthening exercise, nerve mobilizations, progressive walking

45
Q

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?

A

Slump-stretching - less perceived pain, distal sxs

46
Q

What two factors identify a subgroup of patients that may benefit from intermittent traction for the lumbar spine?

A

1) signs of nerve root compression with peripheralization

2) positive crossed SLR

47
Q

What position is intermittent traction performed in for the identified subgroup?

A

Prone

48
Q

Is there evidence to avoid using traction to treat patients with acute/subacute nonradicular LBP or chronic LBP?

A

Yes - moderate evidence that it should NOT be used

49
Q

What six areas should patient education focus on with low back pain?

A

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

50
Q

In the case of low back pain, is low intensity, moderate intensity or high intensity exercise best?

A

Moderate to high intensity

51
Q

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?

A

Progressive, low intensity, submaximal fitness/endurance activities

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