Treatment Based Classification

Question 1

Is a true pathoanatomical diagnosis common for LBP?

Answer 1

No, it is rare.

Question 2

Asymptomatic individuals may show common pathology in high tech imaging?

Answer 2

True

Question 3

Is it easy to find the cause of LBP according to radiographs?

Answer 3

No, abnormal findings are quite common.

Question 4

Should clinicians order routine imagine for patients with LBP?

Answer 4

No!

Question 5

When should clinicians order radiographs?

Answer 5

When pain is severe, or progressive, when neurological deficits are present or when serious underlying conditions are suspected.

Question 6

If a patient with LBP shows signs or symptoms of radiculopathy, or spinal stenosis with MRI or tomography, when do you order imaging?

Answer 6

When they are potential candidates for surgery, or epidural steroidal injections.

Question 7

Radiculopathy is what?

Answer 7

Nerve root disease

EX: Sciatica, or pinched nerve

Question 8

There is a strong association between early imaging in LBP and ______?

Answer 8

Surgery

Question 9

Radiation associated with CT/X-ray increases ______?

Answer 9

Cancer risk

Question 10

Knowledge of results decreases what without improving outcomes?

Answer 10

self rated general outcomes

Question 11

What is the wash out effect?

Answer 11

Many things that we do are not effective for patients with LBP if we don’t identify who actually needs the treatment. Treatment must be individualized.

Question 12

Treatment Based Classification is the what?

Answer 12

classifying clinical data into categories of clinical entities for making decisions regarding therapy management

Question 13

What do we want out of categories of TBC?

Answer 13

Categories that specifically direct treatment

Question 14

What do we want from a classification system?

Answer 14

Improved treatment outcomes; matched treatments should do better than unmatched

Question 15

First level TBC?

Answer 15

Is the patient appropriate for physical therapy management.

Question 16

Second level TBC?

Answer 16

What is the level of acuity?

Question 17

Third level TBC?

Answer 17

What treatment should be used?

Question 18

First level TBC?

Answer 18

Determine referral for medical needs, differential diagnosis AND psychology evaluations

Question 19

Second Level Classification details?

Answer 19

Stage is based on the acuity of a patient. Actuity is determined by nature of presenting symptoms and goals for treatment.

Question 20

Stage I classification in the second level details?

Answer 20

-Unable to perform basic functions ( sit >30 min , stand >15 min, walk 1/4 mile)
-Oswestry Score >30
-Treatment goals: Control Pain
Improve basic function
Reduce disability –> Oswestry Score

Question 21

Stage II, in second level details?

Answer 21

Able to perform basic activities
Unable to perform more functional activities
Oswestry 15-30
Treatment goals: Further reduce disability
-Correct physical impairments
-Improve ability to perform complex

Question 22

Stage III in second level classification?

Answer 22

Able to perform ADLS
Unable to perform demanding or sustained activities
Oswestry usually <15
Treatment goals: Improve ability to perform demanding activities

Question 23

Maitland Model Examination:

Answer 23

SINSS

Question 24

Severity:

Answer 24

Intensity of symptoms and extent they limit normal function.
EX: Pain Scale
Functional limitations : I can bend over and touch my toes but it hurts if i do

Question 25

Irritability

Answer 25

Refers to the ease in which symptoms are produced and time it takes to settle
EX: Symptom onset: Immediately on movement
Symptom relief: Pain goes away immediately when I stand up straight. Pain persists 10-15 minutes after I stand up straight.

Question 26

Nature

Answer 26

Refers to type and extent of degree of injury or illness

Type, tissue injury, degree of injury, and symptom behavior

Question 27

Stage and Stability

Answer 27

Stage: acute, subacute, chronic, acute on chronic

Stability: how are the symptoms changing

Question 28

What are the criteria for a positive response to a spinal manipulation?

Answer 28

Symptoms < 16 days
FABQWK <19
No symptoms distal to the knee
Hip IR > 35 degrees
Lumbar hypomobility

Probability of success if 4 or more are present= 95%, 3+ is at 68% If one is present we are at 1.00 sensitivity and if 5 are present it is 1.00 specificity

Question 29

What are traditional stabilization criteria for classification?

Answer 29

Frequent prior episodes, fluctuation of symptoms, positive response to immobilization, frequent manipulation with short term, dramatic results.
**No clear postural preference, difficulty with extensor muscle activity, pregnancy, distal symptoms.

Physical exam includes; segmental hypermobility, instability catch or movement abberation, a palpable step off, or general ligamentous laxity

Question 30

What is included in aberrant motion assessment?

Answer 30

Painful arc in flexion, or return from flexion

Gower’s sign
Instability Catch
Reversal of lumbo-pelvic rhythm

Question 31

What is included in segmental mobility assessment?

Answer 31

PA glides for segmental mobility and pain provocation.

Positive finding if previous painful segments become pain free during hip extension.

Question 32

How to predict dramatic success for stabilization criteria?

Answer 32

3 or more present:

1) Prone instability test
2) aberrant motion
- Average SLR > 91 degrees
- Age <40

Predicting Oswestry improvement is if 2 or more are present:

Same as above, but FABQ-PA > 8 instead of age,
and
Hypermobility instead of SLR requirement

Question 33

Specific exercise classification requirement?

Answer 33

1) Centralization with movement exam

2) Postural preference

Question 34

Traction classification requirement?

Answer 34

1) Neurological signs
2) Leg symptoms
3) peripheralization with movement test
4) crossed straight leg raise