Subgrouping Patients With Low Back Pain: Evolution of a Classification Approach to Physical Therapy

Low Back Pain

“…Fritz et al, 105 utilizing a randomized clinical trial of 78 patients with acute, work-related low back pain, reported that patients who received interventions matched with their impairments of body function found during the physical examination had better outcomes than patients who received interventions that were not matched with their physical examination findings. The classification system described in this practice guideline linked to the ICF, parallels the treatment-based classification system 103 with 2 noteworthy differences. The first difference is that the labels in this clinical practice guideline incorporate the following ICF impairments of body functions terminology: Low back pain with mobility deficits, low back pain with movement coordination impairments, low back pain with related (referred) lower extremity pain, low back pain with radiating pain, and low back pain with related generalized pain.…”

“…32 This challenge has been taken on largely by researchers who have focused on non-surgical interventions with the goal of identifying sub-groups of patients in whom tailored interventions can be administered with the goal of more rapid recovery. 49, 75, 76, 91, 103, 105, 145, 197 …”

“…For patients who have had low back pain for > 6 months and/or for patients who have recurring low back pain, this clinical guideline promotes categorizing acute, sub acute, and chronic low back pain based on movement/pain relations rather than solely using time since the patient’s initial onset of low back pain. Movement/pain relations are commonly used in physical therapy for classifying patients into treatment categories that respond best to matched interventions strategies 33, 86, 99, 101, 103, 104 as well to guide dosing of manual therapy, therapeutic exercise, and patient education interventions. 172 The dosing of interventions based upon movement/pain relations is consistent with the concept of tissue irritability and is important for guiding the clinical decisions regarding treatment frequency, intensity, duration, and type with the goal of matching the optimal dosage of treatment to the status of the tissue being treated.…”

“…It has been reported that flexion specific-exercise classification appears to be less common and most often occurs in patients who are older, often with a medical diagnosis of lumbar spinal stenosis. 103 Current guidelines detailing conservative intervention for stenosis detail repeated flexion exercises in the supine, seated, and standing position. 27 A recent review article by Backstom et al 12 notes that flexion based exercises have long been utilized to theoretically open or expand the foraminal canals and central spinal canal, and thus, potentially relieving mechanical compression of the lumbar nerve roots, improving spinal flexibility, and improving hemodynamics.…”

A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with mechanical lumbar traction

“…More importantly, there was no study concerning the pre-treatment fearavoidance status of subjects, which is increasingly considered as essential factor in musculoskeletal rehabilitation. The literature review based on few current available studies suggests that traction was most likely to benefit patients with acute (less than 6 weeks' duration) and radicular pain with concomitant neurological deficit [24], and absence of centralization with movement testing [8]. However, the above statement carries rather weak research power.…”