Download Interventions in Treating Patients With Low Back Pain

58 year old female
Work: Inspects products
Chief Complaint: L. LE Throbbing
pain
March, 2016
Pain Onset
June, 2016
Steroidal Injections
(Spaced a week apart)
July, 2016
Starts PT
Tests and Measures:
P-A Spring Testing:
 Mild Hypomobility
 Pain L4-S1
Active Lumbar Ext.:
 Mild pain; 150
Active Lumbar Flex:
 Sharp pain; 450
SLR:
 0-350 caused pain (ipsilateral)
Standing Lumbar Quadrant Ext. with Overpressure:
 +ive
Myotomes:
 L. Knee Extension, L. ankle plantarflexion - 4/5
Slump Test:
 +ive
Health
Health
Condition:
Condition:
• Radiculopathy,
Radiculopathy,
lumbosacral
lumbosacral
region
region
Participation:
Participation:
• Abilities:
Abilities:
Sleep
Able to- sleep
through night
Restrictions:
• Restrictions:
is painful
-Work
Work
Spending
time with Family
- Family
Driving
- Driving
Activity:
Body
Structure
Body
Structure
and Function:
Activity:
Abilities:
• Abilities:
Standing to an extent
- Standing
Limitations:
• Limitations:
Sitting,
putting shoes
- Sitting
Hypomobility
and Function:
Pain
w/ Flex.
• Hypomobility
Pain
w/ Ext.w/ Flex.
• Pain
Decreased Strength
• Pain w/ Ext.
•  Strength
on:
Environmental
Factors
Environmental Factors
+:+: Insurance
Sufficient insurance
Support
from Family
Family
- : Stress of Work
- : Stress of Work
PersonalFactors
Factors
Personal
+ : Motivated
+ : Motivated
- : Stress about getting
better so can work with no
- : Stresspain
(Physical Therapy, 2011)
Objective: To investigate
prevalence and reliability of
placement into a intervention from
translating the use of subgroups to a
classification algorithm
Study Design:
•
•
Cross Sectional, Observational
Study
Test, Retest
(Physical Therapy, 2011)
(Cochrane Database of Systematic Reviews, 2013)
Selection Criteria:
RCT’s involving traction to treat
acute, subacute, or chronic nonspecific LBP w/ or w/0 sciatica (32
RCTs were included)
Outcome Measurements:
• Pain Intensity
• Functional Status
• Global Improvement
• Return to Work
*23/32 studies included mostly people
with LBP and sciatica pain
Results:
• Low to moderate quality evidence - no impact on pain intensity,
functional status, or global improvement
Limitations:
• Amount of high quality studies
• Low to moderate quality evidence - makes little or no difference when
comparing sham, placebo, or no treatment
• 8 studies were a mix of with and
without sciatic
• 1 study had no sciatica pain
• Studies distinguishing between
people with different symptom
patterns
• Very low to moderate quality evidence - makes little or no difference
when comparing physiotherapy and traction or other treatments
Quality of Review: Good2
(Annals of Internal Medicine, 2014)
Objective: To compare spinal manipulative therapy (SMT) plus home
exercise and advice (HEA) vs. HEA alone while studying the reduction in
pain, short term and long term
Study Design:
• 192 patients (191 at 12 wks, 179 at 52 wks)
• 96 patients assigned to each group
• Patients were 21 y.o. or older and have had BRLP for at least 4
wks
Limitations:
• Patients and providers were not
blinded
• Study size
• Back pain potentially gets better
over time
Outcomes:
• Leg Pain
• Low Back Pain
• Global Improvement
• Medication Use
• Satisfaction
*Effect size for leg pain at 12 wks
was considered medium (0.6)
(Annals of Internal Medicine, 2014)
Quality of Study: Fair2
The research I found does not compare traction and
manipulation
Clinical prediction rule for utilization of manipulation as an
intervention for patients with LBP suggests less likelihood of
success for patients with symptoms distal to the knee
Practicing at the top
of Your License!
Remember the 3 legged stool
There is not one intervention
for each diagnosis
If something is not
working, try something
different
Listen to your patients and
figure out their goals to
ultimately give them the best
treatment
http://www.apta.org/Media/Releases/Consumer/2012/4/4/