Title:  Use Of Treatment-Based Classification Groups Produces Significant Outcomes In Patients With LBP

Presentation Type:  Platform

Section:  Orthopedics

Authors:  Scott, Daphne R.; Millar, A. Lynn; Walters, Jason
Institutions: 1.  AthletiCo, Chicago, IL, USA. 2. Physical Therapy, Andrews University, Berrien Springs, MI, USA

Abstract:

Purpose/Hypothesis:  The purpose of this study was to examine the outcomes for patients who received physical therapy for low back pain (LBP) based upon a treatment emphasis, even though the therapists were not specifically trained in the intricacies of the classification process.

Number of Subjects:  Any subject referred to PT for LBP with signed consent for treatment participated. Only subjects who presented with a “non-mechanical” cause of LBP were excluded.

Materials/Methods:  Subjects were assessed for function and impairments using the Modified Oswestry, work status, fear avoidance behaviors questionnaire (FABQ work; FABQ physical), straight leg raise (SLR), and forward bending (FB).  Patients were also classified using the Quebec Task Force Classification System (QTFCS) and the Treatment Based Classification system (TBC).  Demographic variables included age, gender, chronicity of symptoms, and insurance type.  Treatment emphasis was determined by the therapist, based upon the 5 categories of the Treatment Based Classification system.  However, therapists were untrained in the specific clinical examination classification variables used to classify patients into specific treatment groups.  Data were recorded at initial and discharge sessions, and entered into SPSS (12.0).  Descriptive data were calculated for all demographic and dependent variables.  Repeated measures ANOVAs were used to determine differences between TB groups in response to treatment.  Differences were considered significant if at the .05 level of probability.

Results:  133 subjects (79 males, 54 females), with a mean age of 39+13, completed both initial and discharge testing.  There were no differences between the TBC groups for age, gender distribution, initial function or impairment.  There were significant improvements for all functional and impairment measures following PT, however there were no differences in response between the TBC groups or the QTFCS.  Average changes were:  Oswestry =13%, FABQ work=3 points, FABQ physical= 5 points, SLR= 9° and FB = 10°, all at p< .0005.

Conclusions:  As has been shown in the past, PT improves both functional and impairment measures for patients with LBP.  Importantly, the use of a TBC system, even when therapists only used their assessment skills to determine treatment classification categories, and applied no additional criteria, was successful in improving patient outcomes.

Clinical Relevance:  These preliminary results suggest that identification of treatment emphasis based on clinical assessment alone may be as effective in guiding treatment as more elaborate classification schemes.

Keywords:  Low back pain, Treatment, Outcomes.