Subgrouping patients with low back pain: a treatment-based approach to classification

Jeffrey J Hebert, Shane L Koppenhaver, Bruce F Walker, Jeffrey J Hebert, Shane L Koppenhaver, Bruce F Walker

Abstract

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.

Keywords: classification; decision making; exercise; low back pain; manual therapy.

Figures

Figure 1.
Figure 1.
Stepwise decision-making process for patients with low back pain assessed using treatment-based classification.
Figure 2.
Figure 2.
Supine lumbopelvic spinal manipulation technique.
Figure 3.
Figure 3.
Side-lying lumbopelvic spinal manipulation technique.
Figure 4.
Figure 4.
Example of an end-range loading exercise into extension: the prone press-up.
Figure 5.
Figure 5.
Posterior to anterior mobilization to promote lumbosacral extension.

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