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/