Clinical Assessment of Low-Back-Pain Treatment Outcomes in Athletes

2011 ◽  
Vol 20 (1) ◽  
pp. 74-88 ◽  
Author(s):  
Luzita I. Vela ◽  
Douglas E. Haladay ◽  
Craig Denegar
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Outcomes ◽  
Clinical Decision Making ◽  
Outcomes Assessment ◽  
Clinical Decision ◽  
Low Back ◽  
Bottom Line ◽  
Patient Scenario ◽  
Clinical Outcomes Assessment

Patient Scenario:A 21-year-old male rodeo athlete complains of acute low back pain (LBP) after a bareback event. The athlete wishes to compete in a rodeo event in 4 d.Clinical Outcomes Assessment:Given the questionable validity and reliability of traditional clinical examination techniques for LBP, a treatment subgroup classification system combined with clinical outcomes assessment provides greater insight into suitable clinical interventions and patient response to treatment. Four LBP treatment subgroups based on the patient’s clinical presentation and symptoms have been established: manipulation, stabilization, specific exercise, and traction. Manipulation subgroup research has produced a valid clinical prediction rule (CPR). The Visual Analog Scale, Numeric Rating Scale (NRS), Oswestry Low Back Pain Disability Index (ODI), Roland Morris Disability Questionnaire, Short Form 36 (SF-36), and Global Rating of Change Scale are valid, reliable, and responsive outcomes instruments with established values for minimum clinically important difference (MCID). These instruments document important changes in disablement and health-related quality of life in patients with low back injury, as well as demonstrate treatment outcomes.Clinical Decision Making:On examination the athlete presents with moderate pain and disability as measured by the NRS, ODI, and SF-36 and meets all 5 criteria for the manipulation subgroup, indicating a high likelihood of success with manipulative therapy when following the guidelines presented in the CPR. Expected outcomes values, based on MCID values, were met after 1 treatment. Preferred outcomes, based on physical activity requirements for sport, were met on day 4.Clinical Bottom Line:LBP generators are difficult to establish using traditional clinical examination techniques. The combined use of clinical criteria, using an LBP subgroup system, and baseline outcomes measures should guide treatment. Benchmarks should be guided by established MCID values for each instrument.

Clinical Assessment of Ankle Injury Outcomes: Case Scenario Using the Foot and Ankle Ability Measure

2011 ◽  
Vol 20 (1) ◽  
pp. 89-99 ◽  
Author(s):  
Nicole L. Cosby ◽  
Jay Hertel
Keyword(s):  
Decision Making ◽  
Clinical Outcomes ◽  
Clinical Decision Making ◽  
Outcomes Assessment ◽  
Clinical Decision ◽  
Foot And Ankle ◽  
Bottom Line ◽  
Patient Scenario ◽  
Clinical Outcomes Assessment ◽  
Ability Measure

Patient Scenario:A 20-y-old male Division 1 college basketball player sustained a grade 2 inversion ankle sprain during preseason that is preventing him from practicing and competing.Clinical Outcomes Assessment:The Foot and Ankle Ability Measure (FAAM) was administered to the injured athlete as an evaluative tool to provide the clinician with valuable subjective information on the patient’s self-reported function. The FAAM consists of 2 subscales: the activities of daily living (ADL) subscale and the sports subscale. Together the 2 subscales contain 29 questions (21 questions on the ADL and 8 on the sports subscale), which assess self-reported function and disability in the foot and ankle.Clinical Decision Making:The addition of the self-reported functional measures provides the clinician with more quantitative data to make clinical decisions than is possible with typical clinical exams. Self-reported functional assessments should not replace thorough clinical examination or sound clinical judgment; instead they should be an adjunct to them.Clinical Bottom Line:In addition to our objective assessment tools, the FAAM provides clinicians with a tool that can be used to assess function and disability through our patients’ self-reported responses. When used for evaluative purposes the FAAM can measure an individual’s changes in function and disability over time.

Clinical Outcomes Assessment for the Management of Sport-Related Concussion

2011 ◽  
Vol 20 (1) ◽  
pp. 46-60 ◽  
Author(s):  
Tamara C. Valovich McLeod ◽  
Johna K. Register-Mihalik
Keyword(s):  
Clinical Outcomes ◽  
Clinical Decision Making ◽  
Outcomes Assessment ◽  
Clinical Decision ◽  
Bottom Line ◽  
Related Quality ◽  
Patient Scenario ◽  
Health Related ◽  
Clinical Outcomes Assessment

Patient Scenario:An adolescent female youth soccer athlete, with a previous concussion history, suffered a second concussion 4 wk ago. Her postconcussive symptoms are affecting her school performance and social and family life.Clinical Outcomes Assessment:Concussion is typically evaluated via symptoms, cognition, and balance. There is no specific patient-oriented outcomes measure for concussion. Clinicians can choose from a variety of generic and specific outcomes instruments aimed at assessing general health-related quality of life or various concussion symptoms and comorbidities such as headache, migraine, fatigue, mood disturbances, depression, anxiety, and concussion-related symptoms.Clinical Decision Making:The data obtained from patient self-report instruments may not actively help clinicians make return-to-play decisions; however, these scales may be useful in providing information that may help the athlete return to school, work, and social activities. The instruments may also serve to identify issues that may lead to problems down the road, including depression or anxiety, or serve to further explore the nature of an athlete’s symptoms.Clinical Bottom Line:Concussion results in numerous symptoms that have the potential to linger and has been associated with depression and anxiety. The use of outcomes scales to assess health-related quality of life and the effect of other symptoms that present with a concussion may allow clinicians to better evaluate the effects of concussion on physical, cognitive, emotional, social, school, and family issues, leading to better and more complete management.

Clinical Assessment of Upper Extremity Injury Outcomes

2011 ◽  
Vol 20 (1) ◽  
pp. 61-73 ◽  
Author(s):  
Charles Thigpen ◽  
Ellen Shanley
Keyword(s):  
Decision Making ◽  
Clinical Outcome ◽  
Outcome Assessment ◽  
Clinical Outcomes ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Assessment Tools ◽  
Bottom Line ◽  
Patient Scenario ◽  
Clinical Outcomes Assessment

Patient Scenario:The patient presented is a high school baseball pitcher who was unable to throw because of shoulder pain. He subsequently failed nonoperative management but was able to return to pitching after surgery and successful rehabilitation.Clinical Outcomes Assessment:The Disabilities of Arm, Shoulder and Hand (DASH) and the Pennsylvania Shoulder Score (PENN) were selected as clinical outcome assessment tools to quantify the patient’s perceived ability to perform common daily tasks and sport tasks and current symptoms such as pain and patient satisfaction.Clinical Decision Making:The DASH and PENN provide important information that can be used to target specific interventions, set appropriate patient goals, assess between-sessions changes in patient status, and quantify patients’ functional loss.Clinical Bottom Line:Best clinical practice involves the use of clinical outcome assessment tools to garner an objective measure of the impact of a patient’s disease process on functional expectations. This process should facilitate a patient-centered approach by clinicians while they select the optimal intervention strategies and establish prognostic timelines.

scholarly journals Subgrouping Patients With Low Back Pain

2011 ◽  
Vol 3 (6) ◽  
pp. 534-542 ◽  
Author(s):  
Jeffrey J. Hebert ◽  
Shane L. Koppenhaver ◽  
Bruce F. Walker
Keyword(s):  
Decision Making ◽  
Low Back Pain ◽  
Back Pain ◽  
Spinal Manipulation ◽  
Clinical Decision Making ◽  
Treatment Approach ◽  
Clinical Decision ◽  
Low Back ◽  
Stabilization Exercise ◽  
Socioeconomic Burden

Context: Low back pain (LBP) is a prevalent condition imposing a large socioeconomic burden. Despite intensive research aimed at the efficacy of various therapies for patients with LBP, most evidence has failed to identify a superior treatment approach. One proposed solution to this dilemma is to identify subgroups of patients with LBP and match them with targeted therapies. Among the subgrouping approaches, the system of treatment-based classification (TBC) is promoted as a means of increasing the effectiveness of conservative interventions for patients with LBP. Evidence acquisition: MEDLINE and PubMed databases were searched from 1985 through 2010, along with the references of selected articles. Results: TBC uses a standardized approach to categorize patients into 1 of 4 subgroups: spinal manipulation, stabilization exercise, end-range loading exercise, and traction. Although the TBC subgroups are in various stages of development, recent research lends support to the effectiveness of this approach. Conclusions: While additional research is required to better elucidate this method, the TBC approach enhances clinical decision making, as evidenced by the improved clinical outcomes experienced by patients with LBP.

scholarly journals A user-friendly clinical practice guideline summary for managing low back pain in South Africa

2020 ◽  
Vol 76 (1) ◽  
Author(s):  
Jessica Stander ◽  
Karen Grimmer ◽  
Yolandi Brink
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
South African ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Low Back ◽  
End User ◽  
Subacute Low Back Pain ◽  
User Friendly

Background: Clinical practice guidelines (CPGs) provide conveniently packaged evidence-based recommendations to inform clinical decisions. However, intended end-users often do not know how to source, appraise, interpret or choose among CPGs. Moreover, it can be confusing when recommendations on the same topic differ among CPGs, in wording, intent and underpinning evidence.Objectives: This article reports on the processes of: (1) identifying current CPGs for acute and subacute low back pain (LBP) to fit the needs of South African physiotherapists, (2) collating and summarising CPG recommendations to produce a user-friendly end-user product and (3) testing the utility of the summary CPG document on South African physiotherapy clinicians to efficiently determine acceptability, appropriateness and feasibility to inform clinical decision-making.Method: An adapted approach was followed by systematically searching online CPG repositories and online databases for LBP CPGs; screening and critically appraising identified CPGs; summarising recommendations from relevant CPGs and organising them into clinical practice activities. Feedback on utility was obtained from 11 physiotherapists.Results: Three high-quality, international CPGs provided 25 recommendations on the assessment and management of acute and subacute LBP relevant to South African physiotherapy practice. They were organised into 10 headings. Physiotherapy user feedback suggested that this document would assist in clinical decision-making.Conclusion: Organised recommendations extracted from multiple, relevant CPGs provide an end-user-friendly resource for physiotherapists treating LBP.Clinical implications: Collated and organised CPG recommendations may effectively assist South African physiotherapists’ clinical decision-making in assessing and managing patients with acute and subacute LBP.

scholarly journals Novel walking pole gait pattern improves activity in an older adult with chronic low back pain

2021 ◽  
Vol 14 (12) ◽  
pp. e245807
Author(s):  
Evan L Prost ◽  
Carmen C Abbott ◽  
Erin A Dannecker ◽  
Brad W Willis
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Perceived Exertion ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Gait Pattern ◽  
Potential Effect ◽  
Low Back ◽  
Decision Making Model

A 65-year-old woman with chronic low back pain participated in a 1-week community walking poles course. Although the participant received instruction in the standard Nordic walking method, she independently adopted a novel, modified, two-point gait pattern. Subsequently, her pain and activity tolerance using walking poles were monitored at 6 and 12 months. The participant ambulated two times the distance and reported lower ratings of perceived exertion and pain at 6-month and 12month follow-ups when walking with poles compared with walking without poles. This case highlights the potential effect of respecting patient preference within the clinical decision-making model. Doing so empowered a participant with chronic low back pain to adopt a novel, self-selected gait pattern and improve her short-term and long-term outcomes associated with chronic musculoskeletal disease.

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