Clinical Decision Making for Low Back Pain: A Step in the Right Direction

2014 ◽  
Vol 44 (1) ◽  
pp. 1-2 ◽  
Author(s):  
John D. Childs ◽  
Timothy W. Flynn
Keyword(s):  
Decision Making ◽  
Low Back Pain ◽  
Back Pain ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Low Back ◽  
The Right

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.

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.

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.

scholarly journals Simulation in physiotherapy students for clinical decisions during interaction with people with low back pain: randomised controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carolina Sandoval-Cuellar ◽  
Margareth Lorena Alfonso-Mora ◽  
Adriana Lucia Castellanos-Garrido ◽  
Angélica del Pilar Villarraga-Nieto ◽  
Ruth Liliana Goyeneche-Ortegón ◽  
...  
Keyword(s):  
Decision Making ◽  
Low Back Pain ◽  
Back Pain ◽  
Clinical Decision Making ◽  
Clinical Skill ◽  
Role Playing ◽  
Simulated Patients ◽  
Low Back ◽  
Clinical Simulations ◽  
Physiotherapy Students

Abstract Background Low back pain (LBP) is a condition with a high global prevalence, which is getting health professionals’ attention, including physiotherapists as they must have the skills to provide treatment that increases the patient’s quality of life. Clinical simulations could be a pedagogic strategy that facilitates adequate training for students to acquire skills to improve their professional reasoning in this clinical situation. Objective This study sought to determine the effects of clinical simulations with simulated patients (SP) on the physiotherapy students’ clinical decision-making within a role-playing (RP) scenario while caring of LBP patients. Methods This experimental study included 42 participants from two Colombian universities, randomized into two groups (SP, n = 21; RP, n = 21). The clinical skill of performing the Objective Structured Clinical Examination (OSCE-LBP) was evaluated while students cared for patients with LBP; after that, a pedagogical method was conducted that included clinical simulation and, finally, the OSCE-LBP was applied again to compare both groups. Results Changes occurred in the OSCE-LBP among both groups of students: the scores increased (0.66 and 0.59 in RP and SP, respectively), and neither of the two was superior (p value 0.01; 95%CI − 0.21 to 0.23). Conclusion Both types of simulation favor decision-making in professional reasoning in physiotherapy students during interactions with individuals with LBP. Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04428892 Identifying number: NCT04428892. It was retrospectively registered.

scholarly journals Physical Therapists' Clinical Knowledge of Multidisciplinary Low Back Pain Treatment Guidelines

2014 ◽  
Vol 94 (7) ◽  
pp. 934-946 ◽  
Author(s):  
Kenneth E. Learman ◽  
Alyson R. Ellis ◽  
Adam P. Goode ◽  
Christopher Showalter ◽  
Chad E. Cook
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Decision Making ◽  
Treatment Guidelines ◽  
Pain Treatment ◽  
Physical Therapists ◽  
Clinical Decision ◽  
Low Back ◽  
Cross Sectional Survey ◽  
Cross Sectional

Background Numerous clinical practice guidelines (CPGs) have been developed to assist clinicians in care options for low back pain (LBP). Knowledge of CPGs has been marginal across health-related professions. Objective The aims of this study were: (1) to measure US-based physical therapists' knowledge of care recommendations associated with multidisciplinary LBP CPGs and (2) to determine which characteristics were associated with more correct responses. Design A cross-sectional survey was conducted. Methods Consenting participants attending manual therapy education seminars read a clinical vignette describing a patient with LBP and were asked clinical decision-making questions regarding care, education, and potential referral. Descriptive statistics illustrating response accuracy and binary logistic regression determined adjusted associations between predictor variables and appropriate decisions. Results A total of 1,144 of 3,932 surveys were eligible for analysis. Correct responses were 55.9% for imaging, 54.7% for appropriate medication, 62.0% for advice to stay active, 92.7% for appropriate referral with failed care, and 16.6% for correctly answering all 4 questions. After adjustment, practicing in an outpatient facility was significantly associated with a correct decision on imaging. Female participants were more likely than male participants to correctly select proper medications, refer the patient to another health care professional when appropriate, and answer all 4 questions correctly. Participants reporting caseloads of greater than 50% of patients with LBP were more likely to select proper medications, give advice to stay active, and answer all 4 questions correctly. Participants attending more continuing education were more likely to give advice to stay active and older, and more experienced participants were more likely to appropriately refer after failed care. Limitations There was potential selection bias, which limits generalizability. Conclusions The survey identified varied understanding of CPGs when making decisions that were similar in recommendation to the CPGs. No single predictor for correct responses for LBP CPGs was found.

Sign in / Sign up

Export Citation Format

Share Document