| Sumario: | Purpose. Low back pain is a common condition in adolescents, and a specific pathoanatomical origin for the symptoms cannot always be determined. Physical activity level has been identified as a risk factor for the development of back pain in adolescents, but the influence of sports participation on the outcomes of treatment in adolescents has not been adequately examined. The purpose of this work was to examine the clinical outcomes of rehabilitation for adolescents with low back pain, and examine the influence of sports participation on outcomes.Methods. This study was completed in three phases. Phase 1 was a retrospective review of 25 patients under the age of 18 who were seen in one physical therapy clinic for treatment of LBP. Information regarding the patients' medical diagnoses, subjective history, sports participation, clinical examination, and clinical outcomes were collected from chart review. Phase 2 was a retrospective review of 99 patients under the age of 18 with LBP tracked in a large clinical outcomes database. Individual responses and total score on the Numerical Pain Rating Scale (NPRS) and the Modified Oswestry Questionnaire (OSW) were recorded from the patient record. Phase 3 consisted of a prospective study of treatment-based classification of 34 adolescent patients seen in physical therapy for the treatment of their LBP. Treatment duration and content were at the clinician's discretion. Patients completed an OSW and NPRS before and after receiving physical therapy. Additional variables collected included subjective history and clinical examination findings, and sports participation and physical activity. Patients were then classified using a treatment-based classification (TBC) algorithm, and further analysis was performed to examine the effectiveness of classification on clinical outcome.Results. In study 1, initial pain scores were lower if a specific pathology was present (P=.001). Initial pain and OSW scores were poorly correlated (r=0.16). Forty-four percent (n=11) of patients scored under the floor value of 12% on OSW. A second examination of the OSW in 99 patients concluded that OSW was moderately correlated with NPRS (0.59). Chronbach's alpha was 0.86. All 10 items in OSW appeared to load onto two latent factors. When examining the effectiveness of TBC in adolescents with LBP, a classification decision was able to be made with a moderate degree of reliability (0.53 (0.28, 0.79) <= kappa <= 0.89 (.74, 1.0)) in all of the 34 patients. Stabilization was the most commonly prescribed method of treatment by clinicians, while it appeared to only be indicated according to TBC. Those who were matched to their TBC classification experienced fewer numbers of visits than those who were not.Conclusions. It appears the OSW is a valid and reliable tool for assessing clinical outcome of physical therapy intervention for adolescents with LBP. These results also suggest that a TBC approach to treatment of LBP in this population may be effective for improvements in clinical outcome.Keywords. low back pain, outcome measurement, adolescence, Oswestry, treatment-based classification.
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