LBP CPG Flashcards
(51 cards)
According to the CPG, what should the focus of treatment be on?
Preventing reoccurence - transitioning to CLBP
According to the CPG, which gender is more often affected with LBP?
Women > men
What is one single factor which contribute to inc prevalence and worse outcome?
Lower educational standards - has inc prevalence, longer episode duration, worse outcome
Is there an association with a higher physically demanding job and LBP?
Yes - higher prevalence
What are four factors associated with sciatica?
1) Cardiovascular HTN
2) smoking
3) overweight
4) obesity
What type of evidence exists regarding trunk muscle strength and mobility and their roles in LBP?
Inconclusive at best
Which seems to play a greater role in development of LBP: psychosocial or physical factors
Psychosocial - fear, distress/depression, fear avoidance, expectation of recovery, job related satisfaction
Can a pathoanatomical cause be found for most cases of LBP?
No - approx 47% with sxs have abnormality identified
32% of asymptomatic subjects had abnormal lumbar spines
What phase of LBP is occurring with sxs lasting between 2-3 months?
Subacute
What are 3 prognostic indicators for reoccurrence?
1) hx of previous episodes
2) excessive spinal mobility
3) excessive mobility in other joints
What are 5 prognostic indicators for progression to CLBP?
1) presence of sxs below knees
2) psychological distress/depression
3) fear of pain, movement and reinjury - low expectations of recovery
4) high pain intensity
5) passive coping style
Are acute or chronic cases of LBP which are matched with treatment based classification group more successful?
Acute have better outcomes
Does routine imaging seem to result in increased clinical benefit for pts with LBP?
No - seems to contribute to more fear and may lead to harm
Henschke’s 5 factors for identifying spinal fractures:
1) age >50
2) female gender
3) hx of major trauma
4) pain and tenderness
5) co-occurring distracting/painful injury
Henschke’s factor lead to the diagnostic predictive rule for fractures: (4 items)
1) female
2) > 70 years old
3) significant trauma
4) prolong use corticosteroids
True or false: altered patterns of firing, altered cross sectional areas of multifidus and severe fat infiltration has been shown to be associated with LBP
True - muscles of the trunk fire sooner, longer
multifidi are not as active and have high fat infiltration (odds ratio for fat infiltration 9.2)
Factors associated with back-related tumor: (6)
1) Constant pain, no affect from position/activity - worse with WB and at night
2) Age > 50
3) Hx of cancer ** good Sp/+LR
4) Failure to improve in 30 days with conservative intervention (Sn 0.29 / Sp 0.90 - +LR 3 / -LR 0.79)
5) unexplained weight loss
6) no relief with bed rest ** good Sn/-LR
Factors with cauda equina syndrome (4)
1) urine retention *** good Sp/+LR and Sn/-LR
2) fecal incontinence
3) saddle anesthesia
4) sensory / motor deficits in feet (L4,5 - S1)
Factors with back related infection: (5)
1) recent infection (UTI, cellulitis) or IV drug use/abuse
2) concurrent immunosuppressive disorder
3) deep constant ache, inc with WB
4) fever, malaise, swelling
5) spine rigidity - limited accessory motion testing
Factors with abdominal aneurysm: (7)
1) hx of PVD, CAD
2) hx of smoking
3) family hx
4) age > 70
5) non-caucasian
6) female
7) sxs not related to movement stresses / somatic LBP
What is the MCD for the ODI?
10 points out of 100 or 30% from baseline
What is the MCD for the Roland Morris Disability Questionnaire?
5 points of 24 or 30% from baseline
What is the MCD for VAS?
15 on 100 mm scale and 2 on 10 point scale
How is lumbar ROM measured?
Inclinometers placed at the TL junction and on the sacrum
