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PT Dx & Management I: Musculoskeletal II > LS Classification > Flashcards

LS Classification Flashcards

1
Q

The three steps of managing LBP

A

examination
treatment
outcome

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2
Q

What are the goals from a classification system

A

clearly defined categories

improved treatment outcomes

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3
Q

Matching patients to the correct treatment for LBP can improve what two things

A

outcomes of pain and disability in LBP

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4
Q

What section of the CPGs provides an evidence-based outline to guide a classification approach

A

the Orthopaedic section

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5
Q

How do PT track their effectiveness for LBP

A

outcomes

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6
Q

What does TBC stand for

A

treatment based classification system

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7
Q

In the original TBC, that was developed in 1995 by Delitto, how were the patients grouped?

A

they sub grouped people into groups that would respond to types of treatment

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8
Q

What revision was made to the 2007 (Fritz) TBC?

A

they added triaging and staging to the patient

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9
Q

In the most recent revision of the TBC in 2015 (Alrwaily), what was altered?

A

the treatment subgroupings

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10
Q

The 2007 TBC update included evidence on likeliness to respond to what 3 things

A

manipulation
stabilization
directional preference

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11
Q

The 2007 TBC revision used the FABQ as a replacement for

A

Waddels Criteria

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12
Q

Two levels of triage in the 2015 TBC update?

A
  • one at the first-contact health provider (appropriateness of management)
  • 2nd at the level of the rehab provider (determining of rehab approach)
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13
Q

The 2015 TBC update placed patients into which 3 approaches?

A
  • symptom modulation
  • movement control
  • functional optimization approach
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14
Q

Patients requiring manipulation/mobilization, specific exercise, stabilization exercises, traction or rest to modulate pain levels occurs in which approach of the 2015 TBC?

A

symptom modulation

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15
Q

During this approach of the 2015 TBC, patients will benefit from sensorimotor, stabilization or flexibility exercises

A

movement control

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16
Q

Which approach of the 2015 TBC are patients asymptomatic, but need to improve higher level function with physical activities

A

functional optimization approach

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17
Q

Name 5 of the red flags in the TBC stage 1

A 
spinal fracture
neoplasm
ankylosing spondylitis 
cauda equina
AAA
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18
Q

Name 3 yellow flags to evaluate with caution on the TBC stage 1

A

depression
fear avoidance
pain catastophization

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19
Q

In step 1, triage at the level of what?

A

the first healthcare provider

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20
Q

This red flag diagnoses occurs due to major trauma, minor trauma or strain in elderly or the osteoporotic

A

fracture

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21
Q

Risk factors for osteoporotic fracture include (3):

A

increasing age
female
steroid use

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22
Q

This red flag dx has signs and sx of point tenderness over specific vertebrae and spinal pain that is worse with walking/standing and relieved by lying flat

A

fracture

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23
Q

5 most common cancers metastatic to bone

A 
prostate
breast
kidney
thyroid
lung
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24
Q

The spine is the 3rd most common site for metastatic disease, but most common for

A

osseous metastases

25
Q

The 6 findings that help rule in, rule out neoplasm

A 
age >/= 50
previous hx of cancer
duration > 1 month
ESR > 100 mm/hr
anemic (hematocrit)
x-ray
26
Q

This red flag dx has signs and sx of back pain, morning stiffness that improves with exercises an may have systemic issues including uveitis and iritis

A

ankylosing spondylitis

27
Q

Cauda equina syndrome results from dysfunction of what

A

sacral and lumbar nerve roots

28
Q

Patient may present with LBP with or without radiculopathy, lower extremity weakness or sensory changes and absent reflexes?

A

cauda equina syndrome

29
Q

What are 3 special questions that can be asked to rule in cauda equina syndrome

A
  • saddle parasthesia/numbness
  • altered B/B function (urinary incontinence/retention, fecal incontinence)
  • severe or progressive neurological deficit
30
Q

What level of lumbar disc herniation is the most common cause of cauda equina syndrome

A

L4/5 and L5/S1

31
Q

Outside of dysfunction of nerve roots, what are 3 other causes of cauda equina syndrome

A
  • after trauma
  • metastatic disease
  • spinal hemorrhage
32
Q

This red flag dx can occur after trauma, recent procedures with anticoagulant (blood thinner) use, or spontaneously

A

spinal hemorrhage

33
Q

What are the 3 signs and sx of spinal hemorrhages

A
  • acute/progressive paraparesis
  • parasthesia
  • B/B changes - incontinence
34
Q

This can spread as complication of recent surgery, spinal procedure, IV drug use, or penetrating trauma

A

infection

35
Q

This type of infection is typically secondary to a primary source elsewhere in the body

A

spinal infection

36
Q

With an infection, LBP is not relieved with this drug

A

analgesics

37
Q

Even if the WBC may be normal with an infection, what other 2 things are usually elevated

A

ESR and C-reactive protein

38
Q

Factors that increase the risk of developing, or perpetuating long-term disability and work loss associated with LBP

A

yellow flags

39
Q

On the FABQ what is a “high fear” on the activity subscale and a “high fear” on the work subscale?

A
  • activity, 24

- work, 42

40
Q

A high baseline FABQ physical activity subscale can be correlated with what after 6 months

A

a higher disability score

41
Q

There is no correlation between the baseline FABQ physical activity scale and 6-month disability, only if patients receieved what?

A

fear-avoidance based treatment

42
Q

What interventions (4) can be matched to stage 1: symptom modulation of the TBC level 2

A
  • specific exercise/movement
  • mobilization/manipulation
  • traction
  • active rest
43
Q

What interventions (3) can be matched with stage 2: movement control of the TBC level 2

A
  • movement control exercises
  • flexibility deficits (neural, soft tissue, jt)
  • stability
44
Q

What interventions (3) can be matched to stage 3: functional optimization of the TBC level2

A
  • strength/coordination
  • endurance
  • work/sport specific
45
Q

According to CPGs diagnosis/classification, LBP with mobility deficits should have which type of interventions

A

manual therapy and exercise

46
Q

According to the CPGs diagnosis/classification, LBP with movement coordination impairments needs what type of interventions

A

stabilization exercises

47
Q

According to the CPGs diagnosis/classification, LBP with related LE pain or with radiating pain require which interventions

A

centralization and directional preference ex (flexion, extension, lateral shift, traction)

48
Q

If a patient centralize with 2 or more movements in the same direction OR centralizes with movement in one direction and peripheralize with an opposite movement which classification would they go under?

A

specific exercise classification

49
Q

If the patient has a duration of sx <16 days AND NO sx distal to the knee what classification would they fall under?

A

manipulation classification

50
Q

If the pt has 3 or more of the 4 things listed below which classification would they fall under?

  1. avg SLR ROM > 91 deg
  2. (+) prone instability test
  3. (+) aberrant movement
  4. Age < 40 years
A

stabilization classification

51
Q

If the patient peripheralizes with extension movement OR has a (+) crossed SLR test which classification would they fall under?

A

Traction classification

52
Q

What are 3 factors that favor manipulation as an intervention?

A
  • hypomobility with spring testing
  • low FABQ scores (<19)
  • hip IR ROM > 35 deg
53
Q

What are 4 factors against doing manipulations for an intervention?

A
  • sx below the knee
  • increased episode frequency
  • peripheralization with motion testing
  • no pain with spring testing
54
Q

What are the 3 factors that favor stabilization as a intervention for pt?

A
  • hypermobility with spring testing
  • increasing episode frequency
  • 3 or more prior episodes
55
Q

What are the 2 factors that are against stabilization as an intervention?

A
  • discrepancy in SLR ROM (>10 deg)

- Low FABQ scores (<9)

56
Q

Name 3 of the factors for favoring specific exercises as a intervention

A
  • directional preference for extension or flexion
  • centralization with motion testing
  • peripheralization in direction opposite centralization
57
Q

Name the 2 factors that are against the use of specific exercise as an intervention

A
  • low back pain (no distal dx)

- status quo with all movements

58
Q

What is the 1 major factor that favors traction as an intervention

A

peripheralization of sx with no ability to centralize with movement

59
Q

Name the 2 factors that are against using traction as an intervention

A
  • LBP (no distal sx)

- no sign of nerve root compression

PT Dx & Management I: Musculoskeletal II (5 decks)

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