LBP with Mobility Deficits

Question 1

Clinicians should consider using this procedure to reduce pain and disability in pt with mobility deficits and acute LBP and back-related buttock or thigh pain

Answer 1

thrust manipulative procedures

Question 2

These 2 procedures can also be used to improve spine and hip mobility and reduce pain/disability in pt with subacute and chronic LBP and back-related LE pain

Answer 2

thrust manipulative and nonthrust mobilization procedures

Question 3

What is the number 1 reason why manipulation is under-utilized?

Answer 3

anxiety about complications

Question 4

Why is the estimated risk for manipulations so low (<1 per 10,000,000)?

Answer 4

clinicians look for pt to meet the criteria that matches before proceeding to do manipulations

Question 5

What is one potential complication for proceeding with lumbo-sacral manipulation on a patient who does not meet the criteria?

Answer 5

cauda equina syndrome

Question 6

There are several manipulation ABSOLUTE contraindications, what are the 3 manipulation contraindications?

Answer 6

• lack of a dx
• lack of pt consent
• inability to achieve pt positioning due to pain or resistance

Question 7

What does HVLAT stand for?

Answer 7

high velocity, low amplitude technique

Question 8

How do clinicians identify patients with LBP likely to respond to manipulation?

Answer 8

clinical prediction rule

Question 9

What are the 5 manipulation indications?

Answer 9

• hypomobility
• biomechanical assessment
• pain reproduction
• limited AROM
• classification (patient profile)

Question 10

This score is one of the outcome measures utilized to determine if manipulation was a success

Answer 10

oswestry scores

Question 11

What are the five-factor decision rule for doing manipulations on a patient?

Answer 11

1. duration of sx < 16 days
2. FABQ work subscale 18 or less
3. sx NOT distal to the knee
4. at least 1 hip IR PROM > 35 degrees
5. manual stiffness at one or more lumbar levels

Question 12

What is the positive likelihood ratio if 4 or more of the five-factor decision rules for manipulations is present

Answer 12

24.4

Question 13

What are the 3 steps of the clinical decision rule development process?

Answer 13

1. create or derive the rule
2. test or validate the rule
3. assess the impact of the rule on clinical behavior

Question 14

Why do we need to validate the clinical decision rule development process?

Answer 14

• predictors may be based on chance associations
• predictors may be unique to the population studied
• the CDR may be impractical for clinical use

Question 15

How do clinicians measure if the patient may still have pain but better function?

Answer 15

oswestry scores

Question 16

How does manipulation work?

Answer 16

the capsule was stretched, the joint was moved and something mechanical was done

Question 17

Effects as motion has been identified, whether that be joint or nerve or fascia, etc.

Answer 17

biomechanical effects

Question 18

Complex interactions of both the peripheral and central nervous system which comprise the pain experience

Answer 18

neurophysiological effects

Question 19

How can the neurophysiological effects be broken down (3)?

Answer 19

• PNS
• spinal cord mechanism
• supraspinal mechanism

Question 20

What are the 4 reduction effects of thrust manipulation?

Answer 20

• decreased pain pressure threshold at local and distal sites
• decreased temporal summation
• decreased pain
• decreased thermal pain sensitivity

Question 21

What does PPT stand for?

Answer 21

pain pressure threshold

Question 22

What are 4 improving effects of thrust manipulation?

Answer 22

• improved ROM
• improved function
• improved, but transient changes in muscle activation

Question 23

What are the 3 pathoanatomic dx in manipulation/mobility deficits subcategory?

Answer 23

• OA
• facet dysfunction
• DDD