Management of low back pain: a case series illustrating the pragmatic combination of treatment- and mechanisms-based classification systems.

This case series describes the pragmatic use of a treatment-based classification system for the management of four patients with a chief complaint of low back pain. Patients were initially classified into stabilization, manipulation, or specific exercise subgroups based on history and clinical exami...

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Published in:Journal of Manual & Manipulative Therapy (Journal of Manual & Manipulative Therapy) Vol. 15; no. 2; pp. 111 - 123
Main Authors: Pinto D, Cleland J, Palmer J, Eberhart SL
Format: case study pictorial research Journal Article
Published: Journal of Manual & Manipulative Therapy 2007
Online Access:View this record in EBSCOhost
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      dt: 2007
      vid: 15
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      pub: Journal of Manual & Manipulative Therapy
      place: Forest Grove, Oregon
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        106017568
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        10.1179/106698107790819891
        106017568
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        atl: Management of low back pain: a case series illustrating the pragmatic combination of treatment- and mechanisms-based classification systems.
      aug:
        au:
          Pinto D
          Cleland J
          Palmer J
          Eberhart SL
        affil: Regional Transportation District, 1600 Blake St, Denver, CO 80202; Daniel.pinto@rtd-denver.com
      sug:
        subj:
          Low Back Pain Diagnosis
          Low Back Pain Therapy
          Manipulation, Orthopedic
          Range of Motion
          Therapeutic Exercise
          Adult
          Case Studies
          Clinical Assessment Tools
          Disability Evaluation
          Female
          Low Back Pain Classification
          Male
          Middle Age
          Pain Measurement
          Physical Therapy Assessment
          Questionnaires
          Treatment Outcomes
          Human
          Adult: 19-44 years
          Middle Aged: 45-64 years
          Female
          Male
      ab: This case series describes the pragmatic use of a treatment-based classification system for the management of four patients with a chief complaint of low back pain. Patients were initially classified into stabilization, manipulation, or specific exercise subgroups based on history and clinical examination. Each patient was reassessed during the course of clinical care to determine whether to continue treating according to the initially assigned subgroup or to alter management and incorporate a mechanism-based classification addressing identified impairments. Patient #1 was initially classified in the manipulation category. Within three visits, he reported being 'a great deal better' on the Global Rating of Change (GROC) and had a 6-point improvement in his Oswestry Disability Index (ODI). Patient #2, classified in the specific exercise/extension category, reported being 'moderately better' using the GROC and had a 22-point improvement in her ODI within six visits. Patient #3, classified in the stabilization category, reported being 'a very great deal better' on the GROC and had a 30-point improvement in his ODI Index within four visits. Patient #4 was categorized initially in the manipulation category and subsequently in the specific exercise category; after five visits, he noted being 'quite a bit better' using the GROC and he reported a 58-point improvement on his ODI. All four patients in this study were managed using a dynamic pragmatic treatment-based classification approach that allowed for the change of subgroup classification and treatment of impairments and all achieved a clinically meaningful improvement in pain and disability.
      pubtype: Academic Journal
      doctype:
        case study
        pictorial
        research
        Journal Article
      ougenre: Article
    language: English
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