The validity of O’Sullivan’s classification system (CS) for a sub-group of NS-CLBP with motor control impairment (MCI): Overview of a series of studies and review of the literature

Abstract

a b s t r a c tChronic Low Back Pain (LBP) remains a common, recalcitrant and costly problem for the individual sufferer and for society. Effective treatments that reduce the social and economic burden have yet to be established for the majority of chronic LBP cases. Lack of evidence for specific interventions has been blamed on the heterogeneity of the chronic LBP population as well as a lack of a patient centred biopsycho-social approach. This issue of heterogeneity has resulted in classification being considered the highest research priority in the area of chronic LBP. The potential for a 'wash-out effect' caused by the heterogeneity of the chronic LBP populations sampled for randomised controlled clinical trials (RCTs), has driven the need for classifying patients with nonspecific chronic LBP. A summary of a series of studies is outlined in this review paper. They represent a comprehensive investigation into the validity of O'Sullivan's proposed mechanism-based classification system (CS) for a sub-group of localized mechanically provoked nonspecific chronic LBP with motor control impairment (MCI). Further, the findings of these studies are discussed in relation to the relevant literature and the clinical implications arising are presented. Finally, the limitations of this research are outlined and recommendations for future research are made.

Association Between Changes in Electromyographic Signal Amplitude and Abdominal Muscle Thickness in Individuals With and Without Lumbopelvic Pain

“…A possible explanation for the variability in the EMG-thickness relationship is that there are many factors that contribute to morphological change in muscle tissue, of which neuromuscular activation is only one. An alternate explanation is that the participants in this investigation were representative of several subgroups that may become evident by studying larger numbers of individuals 8 and incorporating a measurement of force-tension development for each of the abdominal muscles studied, which is currently not possible.…”

A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: Short-term results of a randomised controlled trial

“…The identification of subgroups requires clinically feasible and reliable screening procedures (Foster et al, 2011). The validity of the clinical diagnosis of the subgroup with MCI and its functional representation is gaining increasing support (Dankaerts & O'Sullivan, 2011;Fersum et al, 2009). To further improve the screening procedure for MCI, six active movement tests have M A N U S C R I P T…”

Reliability of a Treatment-Based Classification System for Subgrouping People With Low Back Pain

“…22 In the absence of a specific pathoanatomical diagnosis and to better direct treatment, a number of research and clinical groups have suggested that there is a need for a system that classifies individuals with LBP based on key clinical symptoms and multidimensional features of the LBP presentation. [1][2][3]8,9,14,29,35 The basis for this suggestion is that people with LBP represent a heterogeneous group, consisting of several smaller homogeneous subgroups. Logically, if the subgroups of patients were classified based on criteria relevant to their specific symptoms, these more homogeneous subgroups would have a higher likelihood of responding to matched treatment approaches.…”