Affiliations: [a] Fysioterapi-och Idrottsskade Metropolen, Ostersund, Sweden | [b] Statistician, Department of Public Health, County Council, Harnosand, Sweden | [c] Department of Neurobiology, Care Sciences and Society and Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
Abstract: Objectives:The purpose of the study was to describe a classification process of patients with low back pain for physical treatment, present a treatment flow and report on short-term outcome. Methods:A multiple subject case study, using a pretest-posttest design was conducted. As short-term outcome measurements, Borg CR 10 pain intensity scale, Oswestry Low Back Pain Disability Questionnaire and the Physical Health Scale from SF36 were used. The subjects were a consecutive sample of 16 adult patients with low back pain, at a physiotherapy clinic in primary care. Inclusion criteria were low back pain, with or without radiating pain and regardless of duration. Exclusion criteria were pregnancy, previous back surgery, and known rheumatic or neurological disease. Patient interview, physical evaluation and two self-reported measurements were decisive for classification to one of four different treatments; pain modulation, stabilization exercise, mobilization, and training. Patients were treated and followed for up to twelve weeks after classification, and compared to baseline measurements at discharge. No comparisons between patients were made. Results:A clinical decision-making algorithm was constructed according to the differences in clinical presentations. A treatment flowchart describes how improved clinical status results in treatment adaptation. Improvements on all short-term outcome measurements were noted in the majority of patients. Conclusion:This pilot study describes an individualized clinical-decision algorithm for sub-grouping patients with low back pain into one of four treatment-based classifications: pain modulation, stabilization exercise, mobilization, and training. The follow up on classification, showing improvements in pain and disability scores at the individual level, suggests that the presented model may be used when clinical decisions on interventions for patients with chronic low back pain are made.
Keywords: Clinical decision-making, physiotherapy, categorization, treatment flow, low back pain
