Lumbopelvic Pain Treatment Classification

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What assessment finding is MOST indicative of the 'Extension' classification in treatment-based classification (TBC) according to Fritz 2007?

Age greater than 50 years.

Visible frontal deviation of the shoulders.

Symptoms distal to the buttock. (correct)

Symptoms of nerve root compression.

Which intervention strategy is NOT typically associated with the 'Flexion' classification in the Fritz 2007 treatment-based classification system?

Manual therapy of the spine and/or lower extremities.

End-range extension exercises. (correct)

Therapeutic exercises to address strength or flexibility impairments.

Body-weight support treadmill ambulation.

A patient presents with a visible frontal deviation of the shoulders relative to the pelvis. According to Fritz 2007, which treatment-based classification subgroup is MOST appropriate?

Flexion

Extension

Lateral shift (correct)

Traction

Which of the following is a PRIMARY selection criterion for the 'Traction' classification within the Fritz 2007 treatment-based classification?

Symptoms of nerve root compression. Signup and view all the answers

According to Alrwaily 2016, which of the following represents a shift in terminology and approach compared to the Fritz 2007 treatment-based classification?

Utilizing broader intervention subgroups based on symptom severity. Signup and view all the answers

Which of the following intervention subgroups is emphasized in the Alrwaily 2016 update to treatment-based classification, reflecting a broader approach to patient management?

Symptom modulation Signup and view all the answers

What is the PRIMARY purpose of the STarT Back Screening Tool, as mentioned in the provided text?

To stratify patients based on their risk of poor outcomes related to persistent disabling pain. Signup and view all the answers

In contrast to the Fritz 2007 classification, the Alrwaily 2016 update emphasizes that classification is primarily based on:

Symptom severity. Signup and view all the answers

What is a primary goal of utilizing a Treatment Based Classification (TBC) system for managing lumbopelvic pain?

To improve patient outcomes by matching them with appropriate interventions. Signup and view all the answers

Delitto's 1995 Treatment Based Classification system primarily focused on which factor for patient classification?

Symptom severity to guide triage and classification. Signup and view all the answers

How did Fritz's 2007 update to the Treatment Based Classification system differ most significantly from Delitto's 1995 version?

It incorporated clinical prediction rules and examination findings for classification. Signup and view all the answers

What is the initial step in developing a Treatment Clinical Prediction Rule (CPR)?

Recruiting patients and providing a standardized treatment to all. Signup and view all the answers

Which of the following is NOT a typical selection criterion for the Manipulation classification within Fritz's 2007 TBC system?

Chronic pain lasting longer than 3 months. Signup and view all the answers

According to the provided material, which of the following is a primary intervention strategy for the 'Stabilization' classification of lumbopelvic pain?

Progressive strengthening of large stabilizing muscles like multifidus and erector spinae. Signup and view all the answers

Which of the following best describes the 'Specific Exercise' classification (though not detailed in the provided text, based on general TBC principles)?

A classification targeting interventions based on directional preference or movement impairment. Signup and view all the answers

What statistical method is used in the development of Treatment Clinical Prediction Rules (CPRs) to identify significant factors?

Statistical regression analysis to identify factors with the greatest predictive value. Signup and view all the answers

Study Notes

Treatment Based Classification of Lumbopelvic Pain

Treatment-based classification systems have evolved over the past 30 years
The goal is to match patients to appropriate treatments
The aim is to improve patient outcomes
The aim is to improve research quality
Studies show that matching interventions to patients' classifications leads to superior outcomes

Objectives

Demonstrate understanding of the Treatment Based Classification system in the management of lumbopelvic pain.

Treatment Based Classification

Match patients with appropriate interventions to improve outcomes
Reduce heterogeneity in research to allow for better comparison of interventions
Make more powerful recommendations and move away from the pathoanatomical model (Delitto 1995, Fritz 2007, Alrwaily 2016).

TBC - Delitto 1995

Organized into 3 broad levels (consultation, physical therapy, referral)
Focused on triage and classifying based on symptom severity (acute, chronic) rather than stage.
First level classification decides which patients can be treated by physical therapists independently verses those needing multidisciplinary management or referral to another healthcare provider
Staging criteria uses Oswestry scores to approximate clinical judgment of functional limitations (eg: sitting, standing, walking). Activities of daily living (ADL), not solely on self-reported limitations
There are three stages of classification (I, II, III) with different intervention focus and goals

TBC - Fritz 2007

Updated based on research since 1995
Focus on examination findings, less on triage or symptom severity
Clinical prediction rules (CPRs) are used in treatment planning
- Tools to make clinical decision making in treatment and diagnosis
- Developed by recruiting patients, conducting standardized history and physical exams, giving everyone the treatment, and statistically determining which factors play the largest role in outcome.

Classifications Based on Fritz 2007

Manipulation:
Recent onset of symptoms (<16 days)
No distal symptoms (below the knee)
Low pain questionnaire (FABQ(W) score <19)
Hypomobility of lumbar spine (e.g., segmental limitation)
Hip internal rotation ROM > 35 degrees
Interventions: HVLAT (thrust) of the lumbopelvic region and AROM exercises.
Stabilization:
Age < 40 years
Greater general flexibility (average SLR >91°)
Instability "catch" (aberrant motion) during trunk flexion/extension
Prone instability test (+ results)
Interventions: Isolated and co-contraction of segmental stabilizing muscles; strengthening large stabilizing muscles; improve function of other stabilizing mechanisms; hydraulic cylinder
Specific Exercises:
Extension: Sx distal to buttock, centralizes with lumbar extension, peripheralizes with lumbar flexion, directional preference for extension, Age > 50 years, imaging evidence of lumbar spinal stenosis. Interventions include: end-range extension exercises, manual therapy, flexibility exercises, body-weight support, and avoidance of flexed positions and flexion activities.
Flexion: Directional preference for flexion, imaging evidence of lumbar spinal stenosis, visible frontal deviation of the shoulders relative to the pelvis, directional preference for lateral translation movements. Interventions include: manual therapy, flexibility exercises, body-weight support, and avoidance of flexed positions and flexion activities.
Lateral shift: Visible frontal deviation of shoulders relative to pelvis, directional preference for lateral translation movements of the pelvis. Interventions include: exercises to correct lateral shift, mechanical, or autotraction.
Traction:
Sx of nerve root compression, no centralization with movements. Interventions include: manual or motorized traction.

TBC - Alrwaily 2016

Updated terminology to align with APTA guidelines
Included psychosocial factors in treatment
Restored triage level and broadened intervention subgroups: symptom modulation, movement control, and functional optimization
Classification based on symptom severity, like earlier models, but also incorporates clinical findings

Triage

Medical management
Rehabilitation management
Self-care management

STarT Back

Subgroups for Targeted Treatment (STarT) Back Screening Tool
Attempts to stratify risk of poor outcomes for patients with persistent disabling pain.

TBC - Alrwaily 2016 - Matching Criteria

This table describes matching criteria for the rehabilitation provider
Factors include patient pain and disability rating, clinical status, psychosocial status, and comorbidities. The table also classifies each aspect for symptom modulation, movement control, and functional optimization.

Questions

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz explores the Treatment Based Classification system for managing lumbopelvic pain. It aims to enhance understanding of how matching interventions to patient classifications can improve outcomes and research quality. Delve into the evolution and application of this system over the past 30 years.