Quiz 1B

Question 1

When interpreting change in score of patient-reported outcome measure, what represents a change that would likely be deemed important by most clinicians?

Answer 1

A change beyond a minimal clinically important difference specific to the outcome being used

Question 2

Of the 154 health conditions studied, which was the most expensive category as discussed in the paper “US Health Care Spending by Payer and Health Condition, 1996-2016 by Dieleman, et al?

Answer 2

Low Back and Neck Pain

Question 3

What is the argument against traditional primary care management of patients with spine related disorders?

Answer 3

Traditional primary care practitioners are generally not well trained in the diagnosis and management of spine related disorders.

Question 4

Which of the following could be considered the key role of the primary spine practitioner?

Answer 4

A broad skill set that enables diagnosis and management of the majority of patients with spine-related disorders without the need for referral.

Question 5

The 5 key psychological factors discussed in Dr. Schneider’s biopsychosocial video presentation are:

Answer 5

Fear/Anxiety, Catastrophizing, Poor Coping, Poor Self Efficacy, Depression

Question 6

Severe mental illness requiring immediate medical attention is typically associated with which of the following “flag” classifications?

Answer 6

Orange Flags

“orange dunce cone”

Question 7

When considering work related spine pain, employee perceptions of workplace conditions that affect recovery from LBP are typically considered:

Answer 7

Blue Flags

blue collar

Question 8

The leading cause of disability in the US

Answer 8

Back and neck pain

Question 9

Your patient presents with subacute, axial low back pain and describes intermittent, 4/10 pain associated with prolonged postural stress and is worse at the end of the day. Which if the following is the most likely pain phenotype characterizing this patient’s pain experience?

Answer 9

Nociceptive dominant

Question 10

Neuroscience pain education is most important for patients that are experiencing _______ pain?

Answer 10

all:
nociceptive inflammatory or mechanical

neuropathic

nociplastic

Question 11

The STarT Back tool is considered a _______ index and helps to establish the relative risk of the patient for _____?

Answer 11

Prognostic; Chronicity

Question 12

Which of the following are clinical signs or symptoms in a patient presenting with low back and extremity pain would be most consistent with nociplastic pain?

Answer 12

Widespread pain that is easily provoked

Question 13

The goals of pain neuroscience education (PNE) typically include which of the following

Answer 13

Helping the patient understand that pain is produced, constructed and modulated by the brain

Question 14

The Treatment Based Classification (TBC) system describes initial triage into categories:

Answer 14

Medical management, rehabilitation management, self-care management

Question 15

A patient with high disability, volatile symptoms and high pain would best fit which approach per the Treatment Based Classification (TBC):

Answer 15

Symptom modulation

Question 16

Directional preference exercises and manipulation/mobilization are typically performed when the patient is which stage of rehabilitation per the Treatment Based Classification (TBC):

Answer 16

Symptom modulation

Question 17

Diagnostic question #1 in the CRISP approach is:

Answer 17

Do the presenting symptoms reflect a visceral disorder or a potentially life threatening illness?

Question 18

Diagnostic question #2 in the CRISP approach is:

Answer 18

Where is the pain coming from?

Question 19

Diagnostic question #3 in the CRISP approach is:

Answer 19

What is happening with this person as a whole that would cause the pain experience to develop and persist?

Question 20

Barriers to implementation of the PSP model in North America include all of the following except:

Answer 20

this is one i really don’t know.
need clarification.
guess:
A lack of postgraduate educational opportunities for PTs and DCs to develop the knowledge skills and abilities necessary to function as a PSP

Question 21

Considering the article Integrating Motivational Interviewing in Pain Neuroscience Education for People With Chronic Pain: A Practical Guide for Clinicians, by Nijs et al, which of the following is a statement/question you would make regarding motivational interviewing that best fits a patient in the Precontemplation Stage - when the patient not considering change says “I’m not willing to simply accept the pain and learn how to live with it; you need to fix the problem that is causing the pain”?

Answer 21

“ I understand why you feel that way. You were told that your “degenerative” or “wear and tear” changes in the lower back [or other body area] seen on the x-rays [MRI, CT] are causing your back pain. Here is a table with the percentage of people—depending on age—who have “wear and tear” changes in their spine despite not having any back or leg pain. Please pick your own age category and read what proportion of people with your age without back or leg pain have “degenerative” or “wear and tear” changes just like you do in their lower spine.” . . . [patient responds] . . .“What does that tell you?” [patient responds] “Perhaps there is more to your pain than just the “wear and tear” changes seen on the x-rays [MRI, CT]? Are you interested to learn about a more comprehensive explanation for your chronic back pain?

Question 22

Considering the article Integrating Motivational Interviewing in Pain Neuroscience Education for People With Chronic Pain: A Practical Guide for Clinicians, by Nijs et al, the goal of Pain Neuroscience Education is to:

Answer 22

Optimize patients’ pain beliefs/perceptions to facilitate the acquisition of adaptive pain coping strategies

Question 23

What touched the outside of Lorimer Mosely’s left leg in his “Why Things Hurt” TedxTalk video:

Answer 23

Eastern brown snake bite

Question 24

Which is the best statement summarizing Lorimer Mosely’s “Why Things Hurt” TedxTalk video:

Answer 24

Pain is a construct of the brain

Question 25

“Centralization” with repeated or sustained end range spinal loading in the Mechanical Diagnosis and Treatment (MDT) system per McKenzie is best described as:

Answer 25

Decrease in distal spine symptoms

Question 26

The “direction of benefit” mechanical response with repeated or sustained end range spinal loading in the Mechanical Diagnosis and Therapy (MDT) system per McKenzie is best described as movements or positions that:

Answer 26

Reduce antalgia/list

Question 27

Which syndrome in the Mechanical Diagnosis and Therapy (MDT) system did Dr. Schneider describe as having the greatest clinical utility?

Answer 27

Derangement

Question 28

The article Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews by Petersen, Laslett, and Juhl, and as Dr. Schneider discussed in the Classification Principles section, found evidence of clusters of tests supporting clinical decision rules for the following conditions?

Answer 28

Symptomatic Intervertebral Disc, SI Joint, Spondylolisthesis, Disc Herniation with Nerve Root Involvement, Spinal Stenosis

Question 29

A PSP should be “multilingual” regarding classification systems in order to?

Answer 29

Foster better clinical reasoning, management and communicate better with patients and other providers

Question 30

The term “Pain Phenotype” describes:

Answer 30

Feature clusters based on mechanisms, the patient’s historical timeline, psychosocial factors, patient needs and goals, and response during clinical evaluation

Question 31

Which phenotype is most classically associated as predominantly “top-down”?

Answer 31

Nociceptive Dominant

Psycho-Emotional Dominant

Question 32

The algorithm/process Dr. Assimakopoulos presented in his overview followed which sequence of steps for determining the best clinical approach for a patient in pain?

Answer 32

What is the directionality (Top down/Bottom up)? – What is the phenotype? – What is the classification (ie TBC, MDT, etc.) - What treatment best fits?

Question 33

Nociceptive dominant mechanical pain is best characterized by:

Answer 33

Dull, Achy, usually intermittent, sharp with movements

Question 34

Nociceptive dominant mechanical pain is best characterized by:

Answer 34

Dull, Achy, usually intermittent, sharp with movements

Question 35

Nociceptive dominant inflammatory pain is best characterized by:

Answer 35

All movements are aggravating with no ability to modify symptoms

Question 36

Which of the following are possible subjective features of neuropathic pain?

Answer 36

Numbness and/or paresthesia within a dermatome or peripheral nerve territory

Question 37

Which of the answers below describes the primary neurophysiological role of the Inflammatory Response?

Answer 37

Heightens the protective response of the nervous system which reduces the patient’s willingness to use of the injured area to enable healing

Question 38

Regarding the Nociplastic Dominant Pain Phenotype, the pneumonic S.P.A.C.E stands for:

Answer 38

Sleep disruption, widespread Pain, Affective involvement, Concertation difficulty, Energy deficit

Question 39

Which of the following is NOT a common feature of the Psycho-Emotional Dominant Pain Phenotype?

Answer 39

Abdominal pain

Question 40

Which is true regarding the P value in a study?

Answer 40

It is a mathematical comparison between groups that assesses the probability that the results are not due to chance

Question 41

Which of the following statements is TRUE regarding the Confidence Interval (CI) in a study:

Answer 41

It is a set of two numbers that show the low and high ends of the range of mean differences between group

Question 42

Evidenced Based Practice is best defined as:

Answer 42

The intersection of using the best research evidence with the clinician’s experience and the patient’s values

Question 43

The PICO acronym in Evidenced Based Practice deals with the components of:

Answer 43

How to ask a good question – Patient/Problem, Intervention, Comparison, Outcome

Question 44

The 5 A’s of Evidenced Based Practice include:

Answer 44

Asking a good question, Acquiring the evidence, Appraising the evidence, Applying the evidence and Assessing the care provided

Question 45

Which is the most accurate statement about a diagnostic test with high SENSITIVITY?

Answer 45

A negative test is helpful in ruling out the disorder/condition

Question 46

Which is the most accurate statement about a diagnostic test with high SPECIFICITY?

Answer 46

A positive test is helpful in ruling in the disorder/condition

Question 47

A randomized trial of 1,000 patients with back pain was conducted. The results stated that treatment A was ‘more effective’ compared with treatment B. This was based upon a p-value being less than 0.05 on the comparison of mean Oswestry scores after treatment. Why are you skeptical of these results?

Answer 47

There is no mention of the magnitude of the treatment effect, or how much difference there was in the Oswestry scores

Question 48

An individual presents to the PSP with an “on again-off again” history of LBP, which has been troubling this individual intermittently for the past 8 months. Currently, this individual states that their pain is acute and markedly more severe, and that they are having considerable difficulty arising from a chair and attaining an upright, erect posture. At this time, this individual can be assessed clinically as:

Answer 48

“Stage One” type of presentation, requiring Symptom Modulation.

Question 49

Good clinical decision making should:

Answer 49

Allow for the conversion of textbook knowledge and experience into the clinical setting.

Question 50

Which of the following is an important attribute of a high quality diagnostic test?

Answer 50

All of the Above