Treatment Based Classification of Lumbopelvic Pain PDF

Treatment Based Classification of Lumbopelvic Pain Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Demonstrate understanding of the Treatment Based Classification system in the management of lum...

Treatment Based Classification of Lumbopelvic Pain Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Demonstrate understanding of the Treatment Based Classification system in the management of lumbopelvic pain.  Treatment Based Classification Match patients with appropriate interventions Improve outcomes Reduce heterogeneity in research Allow for better comparison of interventions Make more powerful recommendations Move away from poor outcomes of pathoanatomical model Delitto 1995, Fritz 2007, Alrwaily 2016  TBC Delitto 1995 organized into 3 broad levels Focused on triage and classifying based on symptom severity rather than stage (e.g. acute, chronic) TBC – Delitto 1995 TBC – Delitto 1995 TBC – Delitto 1995  TBC – Fritz 2007 Updated based on additional research CPRs that had been developed and published since 1995 Focused less on triage and symptom severity and more on examination findings.  Clinical Prediction Rules (CPR) A tool designed to help guide clinical decision making in treatment and diagnosis How are they developed – Treatment CPR Recruit patients Standardized history and physical examination Give everyone the treatment See who gets better Statistical regression analysis to determine what factors played the biggest role  TBC – Fritz 2007 Classifications Manipulation Stabilization Specific Exercise Traction Still often used and cited  TBC – Fritz 2007 Classification Selection Criteria Interventions Manipulation Recent onset of Sx (91o contraction of segmental Instability “catch” (aberrant motion) during stabilizing muscles (LM, trunk flexion or extension AROM TrA) (+) prone instability test Strengthen large stabilizing For postpartum patients muscles -(+) thigh thrust (posterior pelvic pain Improve function of other provocation or P4), ASLR and modified stabilizing mechanisms Trendelenburg tests - IAP -Pain provocation during palpation of long - Hydraulic cylinder dorsal sacroiliac lig or pubic symphysis  TBC – Fritz 2007 Classification Selection Criteria Interventions Specific Exercises Extension Sx distal to buttock End range extension exercises Sx centralize with lumbar extension MJT (non-thrust) to promote extension Sx peripheralize with lumbar flexion Avoidance of flexed position and flexion Directional preference for extension activities Flexion Age > 50 years Manual therapy of the spine and/or LEs Directional preference for flexion Therex to address strength or flexibility Imaging evidence of lumbar spinal stenosis impairments Body-weight support treadmill ambulation Lateral shift Visible frontal deviation of the shoulders Exercises to correct lateral shift relative to the pelvis Mechanical or autotraction Directional preference for lateral translation movements of the pelvis  TBC – Fritz 2007 Classification Selection Criteria Interventions Traction S/Sx of nerve root Manual or compression motorized No centralization with any traction movements TBC – Fritz 2007  TBC – Alrwaily 2016 Update terminology to align with APTA’s published Clinical Practice Guidelines Include psychosocial factors in treatment Restores the triage level Much more broad intervention subgroups: Symptom modulation Movement control Functional optimization Like Delitto 1995, classification is based on symptom severity, not exam findings or stage TBC – Alrwaily 2016  STarT Back Subgroups for Targeted Treatment(STarT) Back Screening Tool Questionnaire attempting to stratify risk of poor outcomes for patients (persistent disabling pain) PDF “Lumbopelvic” folder in Articles folder in Moodle class TBC – Alrwaily 2016 TBC – Alrwaily 2016  Treatment Based Classification Review Treatment based classification systems have evolved in the last 30 years Aim to match patients to appropriate treatment To improve outcomes To improve research quality Several studies have shown superiority to providing intervention that matches a patient’s classification  Objectives Demonstrate understanding of the Treatment Based Classification system in the management of lumbopelvic pain. Questions