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31, No. 36, No. 4, EMC - Kinesiterapia - Medicina Fsica, Vol. 10, 1 May 2019 | Sao Paulo Medical Journal, Vol. Freburger et al101 demonstrated an increase in chronic low back pain from 3.9% (95% CI: 3.4, 4.4) in 1992 to 10.2% (95% CI: 9.3, 11.0) in 2006 in a telephone survey of North Carolina households. 7, Revista Brasileira de Reumatologia, Vol. FOIA Patients were instructed in a quadruped exercise emphasizing lumbar flexion and extension to improve overall joint mobility. 4, 18 August 2022 | Journal of Acupuncture and Tuina Science, Vol. 17, No. The Roland-Morris Disability Questionnaire is a practical alternative to the Oswestry Disability Index. 24, No. -, JAMA. 198, 10 November 2017 | Physiotherapy Theory and Practice, Vol. Prognostic factors for development of recurrent pain include (1) history of previous episodes,280,304 (2) excessive spine mobility,139,191 and (3) excessive mobility in other joints.218,224 Prognostic factors for development of chronic pain include (1) presence of symptoms below the knee,48,175 (2) psychological distress or depression,48,243,249 (3) fear of pain, movement, and reinjury or low expectations of recovery,123,125,126,175,188,282 (4) pain of high intensity,175 and (5) a passive coping style.170,249,297. 1, Journal of Back and Musculoskeletal Rehabilitation, Vol. Judgments are made with regard to a reproduction of symptoms in this position, and relief of symptoms when the cervical spine component is extended or nerve tension is relieved from 1 or more of the lower-limb components, such as ankle plantar flexion or knee flexion. 1, 18 January 2013 | Journal of Occupational Rehabilitation, Vol. Low back pain (LBP) is a common musculoskeletal condition, a leading cause of disability, and one of the costliest medical conditions. 33, No. Manual Physiotherapy Combined with Pelvic Floor Training in Women Suffering from Stress Urinary Incontinence and Chronic Nonspecific Low Back Pain: A Preliminary Study. 4, 30 March 2020 | Turkish Journal of Kinesiology, Journal of Back and Musculoskeletal Rehabilitation, Vol. Clinicians should routinely assess activity limitation and participation restriction through validated performance-based measures. Long and colleagues203 conducted a secondary analysis of a previous randomized controlled trial examining a range of factors that predict a favorable outcome where patients were subgrouped based on the presence or absence of directional preference. Lanatomie au service de la clinique, Telerehabilitation booster sessions and remote patient monitoring in the management of chronic low back pain: A case series, Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis, Reducing Opioid Use for Patients With Chronic Pain: An Evidence-Based Perspective, Paradigm Shift in Geriatric Low Back Pain Management: Integrating Influences, Experiences, and Consequences, McKenzie Method of Mechanical Diagnosis and Therapy was slightly more effective than placebo for pain, but not for disability, in patients with chronic non-specific low back pain: a randomised placebo controlled trial with short and longer term follow-up, Prevalence and Characterization of Breakthrough Pain Associated with Chronic Low Back Pain in the South of Spain: A Cross-Sectional, Multicenter, Observational Study, Meta-analysis of transcutaneous electrical nerve stimulation for relief of spinal pain, Comparison of the Cost-utility Analysis of Electroacupuncture and Nonsteroidal Antiinflammatory Drugsin the Treatment of Chronic Low Back Pain, Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study, Clinical classification criteria for nonspecific low back pain: A Delphi-survey of clinical experts, Clinical utility of the Oswestry Disability Index for measuring the function of patients with low back pain, Systematic Review of Factors Influencing Surgical Performance: Practical Recommendations for Microsurgical Procedures in Neurosurgery, Physical therapy clinical specialization and management of red and yellow flags in patients with low back pain in the United States, Webinar: Spondylolysis in Adolescents: Diagnosis, Treatment, and Outcomes, Low back pain and disability in individuals with plantar heel pain, Escuelas de espalda en atencin primaria: revisin sistemtica para un enfoque biopsicosocial, Quality, language, subdiscipline and promotion were associated with article accesses on Physiotherapy Evidence Database (PEDro), Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review, The Influence of Patient Choice of First Provider on Costs and Outcomes: Analysis From a Physical Therapy Patient Registry, Aquatic Exercises in the Treatment of Low Back Pain, Review article: Best practice management of low back pain in the emergency department (part 1 of the musculoskeletal injuries rapid review series), Evaluation of biofeedback based bridging exercises on older adults with low back pain: A randomized controlled trial. The Orthopaedic Section, APTA also selected consultants from the following areas to serve as reviewers of the early drafts of these clinical practice guidelines: Comments from these reviewers were utilized by the authors to edit these clinical practice guidelines prior to submitting them for publication to the Journal of Orthopaedic & Sports Physical Therapy. 53, No. Disclaimer, National Library of Medicine Primary Investigation of Low Back Pain among Saudi Arabians: A Cross-Sectional Study. ), INTERVENTIONS - FLEXION EXERCISES: Clinicians can consider flexion exercises, combined with other interventions such as manual therapy, strengthening exercises, nerve mobilization procedures, and progressive walking, for reducing pain and disability in older patients with chronic low back pain with radiating pain. 3, Patient Education and Counseling, Vol. The patient lies prone with the body on the examining table, legs over the edge and feet resting on the floor. Furthermore, Savage et al264 reported that 32% of their asymptomatic subjects had abnormal lumbar spines (evidence of disc degeneration, disc bulging or protrusion, facet hypertrophy, or nerve root compression) and only 47% of their subjects who were experiencing low back pain had an abnormality identified. In a follow-up study involving an inception cohort of patients seeking primary care treatment for low back pain, the rate of serious pathology was quite low (0.9%), with most of the identified red flag cases, 8 of 11, being spinal fractures.150 Because most patients had at least 1 red flag, Henschke et al150 have cautioned against use of isolated red flags because of poor diagnostic accuracy. Does the use of interferential current prior to pilates exercises accelerate improvement of chronic nonspecific low back pain? Identification of psychological factors is assisted with the use of standard questionnaires described in the Measures section of these clinical guidelines. 33, No. Like the Oswestry Disability Index, the Roland-Morris Disability Questionnaire has excellent psychometrics, is easy to administer, and has been shown to be responsive in clinical trials. 2 Two questions are as good as many, A study of computer-assisted tomography. Overall, most guidelines target nonspecific LBP and recommend education, staying active/exercise, manual therapy, and paracetamol or NSAIDs as first-line treatments. The Oswestry Disability Index has long-standing recognition as an acceptable standard, with numerous studies that establish its reliability, validity, and responsiveness. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. 7, 18 March 2022 | Medicine, Vol. 2016;96:10571066. 2, Nigerian Journal of Experimental and Clinical Biosciences, Vol. Aberrant movement includes the presence of any of the following: painful arc with flexion or return from flexion, instability catch, Gower sign, and reversal of lumbopelvic rhythm. Clinicians should consider diagnostic classifications associated with serious medical conditions or psychosocial factors and initiate referral to the appropriate medical practitioner when (1) the patient's clinical findings are suggestive of serious medical or psychological pathology, (2) the reported activity limitations or impairments of body function and structure are not consistent with those presented in the diagnosis/classification section of these guidelines, or (3) the patient's symptoms are not resolving with interventions aimed at normalization of the patient's impairments of body function. Numerous other case studies have described utilization of lower extremity nerve mobilization procedures for lower-limb symptoms.63,64,122,185,294 Diagnoses utilized in these reports included hamstring strain and complex regional pain syndrome. Kappa values are reported to be moderate to good for pain provocation during spring testing of the lumbar vertebrae ( = 0.250.55), Measurement of impairment of body function - pain in back; pain in lower limb; and mobility of several joints. 2, International Journal of Osteopathic Medicine, Vol. 30, Musculoskeletal Science and Practice, Vol. We also aimed to examine how recommendations have changed since our last overview in 2010. 43, No. (Recommendation based on strong evidence. 7, 1 July 2017 | Scandinavian Journal of Pain, Vol. 46, No. A similar process is used for side bending with the inclinometer aligned in the frontal plane, and the patient is asked to bend to each side. 9, EMC - Medicina Riabilitativa, Vol. 18, No. HHS Vulnerability Disclosure, Help There are numerous alternate test positions for all described muscle groups. The STarT Back Screening Tool was originally developed for use in primary care settings, where it has demonstrated sound measurement properties,159 and recently the STarT Back Screening Tool demonstrated potential for its use in physical therapy settings.104 Finally, there is a 5-item clinical prediction tool developed in primary care to identify patients with low back pain who are at risk for long-term functional limitations. The lead author (A.D.) assigned a specific subcategory (classification, measures, and intervention strategies for musculoskeletal conditions of the low back region) to search based upon their specific area of expertise. 2, Journal of Geriatric Physical Therapy, Vol. 96, No. Clinicians should not utilize patient education and counseling strategies that either directly or indirectly increase the perceived threat or fear associated with low back pain, such as education and counseling strategies that (1) promote extended bed-rest or (2) provide in-depth, pathoanatomical explanations for the specific cause of the patient's low back pain. Of the 25 selected randomized controlled trials, only 5 trials were considered high quality. After analyzing a wide array of data, Dr. 4, 30 April 2016 | Journal of Orthopaedic & Sports Physical Therapy, Vol. 10, No. 2017 Feb;21(2):201-216. doi: 10.1002/ejp.931. Bethesda, MD 20894, Web Policies 7, 16 June 2022 | Frontiers in Aging Neuroscience, Vol. A practical approach, A randomised clinical trial of subgrouping and targeted treatment for low back pain compared with best current care. 2021 Sep 22;21(1):236. doi: 10.1186/s12906-021-03401-3. Most clinicians, however, perceive that recognizable subgroups exist, and researchers agree that clinical care may be improved with effective subgrouping methods. The mean improvement in disability as measured by the Roland-Morris Disability Index score was 5.1 points from baseline to discharge, and 5.2 points from baseline to long-term follow-up, satisfying the criterion for minimum clinically important difference. There are a variety of tools used to assess functional capacity in a work setting. 99, No. Front Aging Neurosci. 17, No. The examiner contacts each lower thoracic and lumbar spinous process with the thumbs (or alternately with the hypothenar eminence just distal to the pisiform). 9, The Journal for Nurse Practitioners, Vol. Reiman et al,252 in a recent systematic review, recommended manual therapy techniques including thrust and nonthrust mobilization/manipulation to the lumbopelvic region for patients with lumbar spinal stenosis. Cervical flexion, knee extension, and ankle dorsiflexion are sequentially added up to the onset of patient lower extremity symptoms. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview Authors Crystian B Oliveira 1 , Chris G Maher 2 3 , Rafael Z Pinto 4 , Adrian C Traeger 2 3 , Chung-Wei Christine Lin 2 3 , Jean-Franois Chenot 5 , Maurits van Tulder 6 , Bart W Koes 7 8 Affiliations 20, Journal of Manipulative and Physiological Therapeutics, Vol. This was published in a Cochrane review. George121 published a case series of 6 patients with subacute low back pain and leg symptoms who (1) were unable to improve or worsen their symptoms with lumbar flexion and extension motions, and (2) had a positive slump test. -, Implement Sci. 33, No. 2, 27 October 2016 | Sports Health: A Multidisciplinary Approach, Vol. 41, No. We identified 15 clinical practice guidelines for the management of low back pain in primary care. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? 76, No. Despite its popularity, recent systematic reviews have demonstrated marginal treatment effects across heterogeneous groups of patients with low back pain.10,11 Also, most trials have assessed the efficacy of mobilization/manipulation in isolation rather than in combination with active therapies. The authors concluded that those patients who centralize with lumbar extension movements preferentially benefit from an extension-oriented treatment approach. Depression is a commonly experienced illness or mood state, with a wide variety of symptoms ranging from loss of appetite to suicidal thoughts.242 Depression is commonly experienced in the general population, but it appears to be more commonly experienced in conjunction with chronic low back pain.12,75,136 Depressive symptoms are associated with increased pain intensity, disability, medication use, and unemployment for patients with low back pain.286 Based on this epidemiological information, routine screening for depression should be part of the clinical examination of low back pain. 5, Complementary Therapies in Medicine, Vol. 4, Archives of Physical Medicine and Rehabilitation, Vol. 36, No. Researchers have shown that psychosocial factors are an important prognostic indicator of prolonged disability.315. Changes in the patient's level of activity limitation and participation restriction should be monitored with these same measures over the course of treatment. 14, No. Southerst D, Marchand AA, Ct P, Shearer HM, Wong JJ, Varatharajan S, Randhawa K, Sutton D, Yu H, Gross DP, Jacobs C, Goldgrub R, Stupar M, Mior S, Carroll LJ, Taylor-Vaisey A. J Manipulative Physiol Ther. effective implementation of cpgs to augment initial clinical decision making during physical therapy management of patients with spine related musculoskeletal pain will have several important goals: 1) improve patient pain and disability outcomes, 2) limit over utilization of physical therapy services, and 3) increase adherence to limit 15, 15 February 2021 | Disability and Rehabilitation, Vol. This is especially true in decisions regarding activity limitations and participation restrictions (eg, return to work). 119, No. The clinical course of low back pain can be described as acute, subacute, recurrent, or chronic. 13, 31 May 2019 | Journal of Orthopaedic & Sports Physical Therapy, Vol. These parameters of practice should be considered guidelines only. For example, clinicians frequently are required to assist patients with managing acute exacerbations of chronic low back pain conditions. The Oswestry Disability Index is a commonly utilized outcome measure to capture perceived disability in patients with low back pain.113,118 Originally described by Fairbank et al,96 there are also modified versions widely reported in the literature.113,118 This index contains 10 items: 8 related to activities of daily living and 2 related to pain. Interdisciplinary clinical guidelines. 49, No. This test-item cluster was validated by Childs et al,51 who demonstrated similar results with patients meeting 4 of the 5 predictors who received thrust manipulation (+LR = 13.2; 95% CI: 3.4, 52.1). For acute low back pain with mobility deficits, the distinguishing movement/pain characteristic is that the patient demonstrates restricted spinal range of motion and segmental mobility, and that the patient's low back and low back-related lower extremity symptoms are reproduced with provocation of the involved segments, with intervention strategies focused on reducing pain and improving mobility of the involved spinal segments. Pain provocation during mobility testing. 1, 1 January 2022 | Coluna/Columna, Vol. 1, No. 10.2, Current Medicinal Chemistry, Vol. Standards of care are determined on the basis of all clinical data available for an individual patient and are subject to change as scientific knowledge and technology advance and patterns of care evolve. 100, No. 1, No. A survey of recognized clinical specialists in orthopaedic physical therapy identified that patient education strategies consisting of Educate patient in home care treatment program and Recommends strategies to prevent recurrent problems ranked as the highest 2 out of a list of 12 intervention strategies.216 In addition, Functional movement training/re-education was ranked as a very important strategy for therapists to implement in their plan of care for patients.216 For patients with low back pain, this commonly involves identifying movements that are associated with low back pain, such as excessive flexion of the lumbar spine when rising from a chair instead of utilizing flexion of the hip for executing the movement, then providing cuing and education on movement options that enable the activity to be performed with fewer, or no, symptoms. The results of their randomized trial indicated that lumbar spinal stabilization exercises under the direction of a physical therapist were superior to performing a general exercise program independently at home and to a control group of no prescribed exercises at 3 months. 19, No. These slides can be retrieved under Electronic Supplementary Material. doi:10.2519/jospt.2021.0507, Journal of Orthopaedic & Sports Physical Therapy, US health care spending by payer and health condition, 19962016, What are the most common conditions in primary care? Genetic factors have been linked to specific disorders of the spine such as disc degeneration.17 The link of heredity to development of nonspecific low back pain, however, remains questionable. One example is the rebro Musculoskeletal Pain Questionnaire (OMPQ). A method for grading health care recommendations.
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