How has the treatment-based classification system for low back pain been updated?
The treatment-based classification (TBC) system for the treatment of patients with low back pain (LBP) has been in use by clinicians since 1995. This perspective article describes how the TBC was updated by maintaining its strengths, addressing its limitations, and incorporating recent research deve …
What are the nonpharmacologic treatments for acute low-back pain?
May 12, 2017 · Identifying diagnostic, prognostic and treatment orientated subgroups of patients with low back pain (LBP] has been on the research agenda for many years [1, 2]. Diagnostic reasoning with a structural/pathoanatomical focus is common among clinicians , and it is regarded as an essential component of the biopsychosocial model [4–6]. Within this model, …
How to optimize the treatment effect in patients with low back pain?
We emphasize that treatment for patients with low back pain is not a static process. Rather, the treatment is a fluid process that changes as the clinical status of the patient changes. This movement control approach is based on clinical experience and indirect evidence; further research is needed to support its clinical utility.
How are patients with low back pain (LBP) classified?
Jan 11, 2016 · Treatment-Based Classification and Its Evolution. According to the Low Back Pain Clinical Guidelines published by Delitto et al, “The best available evidence supports a classification approach that de-emphasizes the importance of identifying specific anatomical lesions after red flag screening is completed.” Within the physical therapy community, there are several unique …
How do you classify low back pain?
What is treatment based classification?
What is the primary treatment intervention for low back pain?
What is a classification of back pain based on duration?
What is non specific low back pain?
What is mechanical back pain?
What are the causes of low back pain?
- Muscle or ligament strain. Repeated heavy lifting or a sudden awkward movement can strain back muscles and spinal ligaments. ...
- Bulging or ruptured disks. Disks act as cushions between the bones (vertebrae) in your spine. ...
- Arthritis. ...
- Osteoporosis.
How do physios treat low back pain?
What is the major cause of lower back pain?
What is defined as lower back?
What is the difference between lumbago and low back pain?
What is the difference between mechanical and non mechanical pain?
Is Medical Imaging the Answer?
The accuracy of the pathoanatomical model in diagnosing and treating LBP is severely overrated. Multiple imaging studies have proven this model is limited by the high rate of false-positives.
Treatment-Based Classification and Its Evolution
According to the Low Back Pain Clinical Guidelines published by Delitto et al, “The best available evidence supports a classification approach that de-emphasizes the importance of identifying specific anatomical lesions after red flag screening is completed.” Within the physical therapy community, there are several unique classification systems, but only one is backed by a substantial bounty of evidence.
Treatment-Based Classification Yields Better Outcomes
In 2000, Fritz et al published a prospective cohort study looking at short-term patient outcomes after matching patient sub-groups to their corresponding treatment strategies. This study evaluated the outcomes of 120 patients receiving physical therapy for acute LBP.
Why It Works: Superior Interventions or the Matching Principle?
What if the interventions being provided from the previous clinical guideline standards were simply inferior to the techniques used by the classification group? Would proper pairing of presentation to treatment remain an important factor in outcomes when the same interventions were used throughout the patient population?
The Most Effective Evidence-Based Tool for Low Back Pain
This classification system has been rigorously evaluated and has come out with moderate to good inter-rater reliability regardless of clinician experience or expertise. This goes along with the improved clinical outcomes and decreased healthcare costs seen in two large randomized controlled trials.
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When was the TBC revised?
A revision of the TBC was published in 2007 by Fritz et al 15 with the purpose of updating the 1995 TBC with the latest evidence that emerged between 1995 and 2007. This revision and update represented the second phase of development. The major strength of the 2007 TBC was that it was much more evidence-based.
What is a TBC?
The treatment-based classification (TBC) system for the treatment of patients with low back pain (LBP) has been in use by clinicians since 1995. This perspective article describes how the TBC was updated by maintaining its strengths, addressing its limitations, and incorporating recent research developments. The current update of the TBC has 2 levels of triage: (1) the level of the first-contact health care provider and (2) the level of the rehabilitation provider. At the level of first-contact health care provider, the purpose of the triage is to determine whether the patient is an appropriate candidate for rehabilitation, either by ruling out serious pathologies and serious comorbidities or by determining whether the patient is appropriate for self-care management. At the level of the rehabilitation provider, the purpose of the triage is to determine the most appropriate rehabilitation approach given the patient's clinical presentation. Three rehabilitation approaches are described. A symptom modulation approach is described for patients with a recent—new or recurrent—LBP episode that has caused significant symptomatic features. A movement control approach is described for patients with moderate pain and disability status. A function optimization approach is described for patients with low pain and disability status. This perspective article emphasizes that psychological and comorbid status should be assessed and addressed in each patient. This updated TBC is linked to the American Physical Therapy Association's clinical practice guidelines for low back pain.
What is the TBC system?
In this article, we focus on the TBC system described by Delitto et al. 11 The TBC is the most extensively researched classification system in the field of physical therapy, with more than 16 articles investigating its usefulness as a guide for clinical decision making. 13 Since its publication in 1995, the TBC has passed through phases of development that were largely based on emerging evidence. At each phase, the TBC had different strengths and limitations. The purpose of this article is to review those strengths and limitations and use current evidence to update the TBC approach. Specifically, the update of the TBC will take into consideration the following points: 1 Recognition that the initial triage process includes all health care providers who come in first contact with patients with LBP. 2 Establishing decision-making criteria for the first-contact practitioner to triage patients into 1 of 3 approaches: medical management, rehabilitation management, and self-care management ( Fig. 1 ). 3 Utilizing risk stratification and psychosocial tools to determine which patients require psychologically informed rehabilitation. 4 Updating decision-making criteria for the triage process by rehabilitation providers to determine the most appropriate rehabilitation approach ( Table, Fig. 1 ). 5 Linking the components of the TBC to the APTA clinical practice guidelines for LBP. 6 Proposing a course of action addressing the limitations of the previous versions of TBC, including the development of a novel neuromuscular assessment, prioritizing interventions, and identifying a research agenda.
When was the TBC system created?
The original TBC system was created in 1995 by a panel of experts with the purpose of describing a classification system that specifically directed conservative management to patients with LBP. 11 The 1995 TBC system was designed, in part, to be analyzed critically and serve as the basis for scientific inquiry.
What is movement control?
A movement control approach is matched to patients who have low-to-moderate levels of pain and disability that interfere with their activities of daily living ( Table ). The patient's status tends to be stable; that is, the patient describes a low baseline level of pain that increases by doing certain daily activities; however, the pain returns to its low-level baseline as soon as the patient ceases the activity. Other patients may describe recurrent attacks of LBP that are aggravated with sudden or unexpected movement, but currently they are asymptomatic or in remission. The patient's active spinal movements are typically full but may be accompanied by aberrant movements. The physical examination can reveal findings of impaired flexibility, muscle activation, and motor control. These patients need interventions to improve the quality of their movement system. For this group, the treatment in the 2007 TBC system mainly relied on stabilization exercises. 16, 35 In this updated 2015 TBC, however, we believe that stabilization exercises must be better defined, and other treatments need to be explored.
What is functional optimization?
A functional optimization intervention is for patients who are relatively asymptomatic; they can perform activities of daily living but need to return to higher levels of physical activities (eg, sport, job). The patient's status is well controlled ( Table ); that is, the pain is aggravated only by movement system fatigue. These patients may not have flexibility or control deficits, but they have impairments in movement system endurance, strength, and power that do not meet their physical demands. 36 These patients need interventions that maximize their physical performance for higher levels of physical activities. For this group, the treatment should optimize the patient's performance within the context of a job or sport.
Treatment-Based Classification System for LBP
Low back pain patients are not a homogeneous group, but unfortunately they are often times treated like one. There is an overwhelming amount of causes of pain (disc, ligaments, facet joint capsules, muscle strain/spasm, stress fracture, etc.) and possible diagnosis for low back pain.
Treatment-Based Classification System
There are more than 3 categories described here, but the other categories are either subcategories or irrelevant. Specific exercise category has 3 subcategories (flexion, extension, and lateral shift). And I personally do not consider traction a valid category to consider.
Bottom Line
Of course this is not a method that is intended to be dogmatic. This is a simplification process used to help classify a difficult patient population for an effective treatment. It gives healthcare professionals a logical and methodical means of how to begin low back patients rehab.
