LS Classification

Question 1

The three steps of managing LBP

Answer 1

examination
treatment
outcome

Question 2

What are the goals from a classification system

Answer 2

clearly defined categories

improved treatment outcomes

Question 3

Matching patients to the correct treatment for LBP can improve what two things

Answer 3

outcomes of pain and disability in LBP

Question 4

What section of the CPGs provides an evidence-based outline to guide a classification approach

Answer 4

the Orthopaedic section

Question 5

How do PT track their effectiveness for LBP

Answer 5

outcomes

Question 6

What does TBC stand for

Answer 6

treatment based classification system

Question 7

In the original TBC, that was developed in 1995 by Delitto, how were the patients grouped?

Answer 7

they sub grouped people into groups that would respond to types of treatment

Question 8

What revision was made to the 2007 (Fritz) TBC?

Answer 8

they added triaging and staging to the patient

Question 9

In the most recent revision of the TBC in 2015 (Alrwaily), what was altered?

Answer 9

the treatment subgroupings

Question 10

The 2007 TBC update included evidence on likeliness to respond to what 3 things

Answer 10

manipulation
stabilization
directional preference

Question 11

The 2007 TBC revision used the FABQ as a replacement for

Answer 11

Waddels Criteria

Question 12

Two levels of triage in the 2015 TBC update?

Answer 12

• one at the first-contact health provider (appropriateness of management)
• 2nd at the level of the rehab provider (determining of rehab approach)

Question 13

The 2015 TBC update placed patients into which 3 approaches?

Answer 13

• symptom modulation
• movement control
• functional optimization approach

Question 14

Patients requiring manipulation/mobilization, specific exercise, stabilization exercises, traction or rest to modulate pain levels occurs in which approach of the 2015 TBC?

Answer 14

symptom modulation

Question 15

During this approach of the 2015 TBC, patients will benefit from sensorimotor, stabilization or flexibility exercises

Answer 15

movement control

Question 16

Which approach of the 2015 TBC are patients asymptomatic, but need to improve higher level function with physical activities

Answer 16

functional optimization approach

Question 17

Name 5 of the red flags in the TBC stage 1

Answer 17

spinal fracture
neoplasm
ankylosing spondylitis 
cauda equina
AAA

Question 18

Name 3 yellow flags to evaluate with caution on the TBC stage 1

Answer 18

depression
fear avoidance
pain catastophization

Question 19

In step 1, triage at the level of what?

Answer 19

the first healthcare provider

Question 20

This red flag diagnoses occurs due to major trauma, minor trauma or strain in elderly or the osteoporotic

Answer 20

fracture

Question 21

Risk factors for osteoporotic fracture include (3):

Answer 21

increasing age
female
steroid use

Question 22

This red flag dx has signs and sx of point tenderness over specific vertebrae and spinal pain that is worse with walking/standing and relieved by lying flat

Answer 22

fracture

Question 23

5 most common cancers metastatic to bone

Answer 23

prostate
breast
kidney
thyroid
lung

Question 24

The spine is the 3rd most common site for metastatic disease, but most common for

Answer 24

osseous metastases

Question 25

The 6 findings that help rule in, rule out neoplasm

Answer 25

``` age >/= 50 previous hx of cancer duration > 1 month ESR > 100 mm/hr anemic (hematocrit) x-ray ```

Question 26

This red flag dx has signs and sx of back pain, morning stiffness that improves with exercises an may have systemic issues including uveitis and iritis

Answer 26

ankylosing spondylitis

Question 27

Cauda equina syndrome results from dysfunction of what

Answer 27

sacral and lumbar nerve roots

Question 28

Patient may present with LBP with or without radiculopathy, lower extremity weakness or sensory changes and absent reflexes?

Answer 28

cauda equina syndrome

Question 29

What are 3 special questions that can be asked to rule in cauda equina syndrome

Answer 29

- saddle parasthesia/numbness - altered B/B function (urinary incontinence/retention, fecal incontinence) - severe or progressive neurological deficit

Question 30

What level of lumbar disc herniation is the most common cause of cauda equina syndrome

Answer 30

L4/5 and L5/S1

Question 31

Outside of dysfunction of nerve roots, what are 3 other causes of cauda equina syndrome

Answer 31

- after trauma - metastatic disease - spinal hemorrhage

Question 32

This red flag dx can occur after trauma, recent procedures with anticoagulant (blood thinner) use, or spontaneously

Answer 32

spinal hemorrhage

Question 33

What are the 3 signs and sx of spinal hemorrhages

Answer 33

- acute/progressive paraparesis - parasthesia - B/B changes - incontinence

Question 34

This can spread as complication of recent surgery, spinal procedure, IV drug use, or penetrating trauma

Answer 34

infection

Question 35

This type of infection is typically secondary to a primary source elsewhere in the body

Answer 35

spinal infection

Question 36

With an infection, LBP is not relieved with this drug

Answer 36

analgesics

Question 37

Even if the WBC may be normal with an infection, what other 2 things are usually elevated

Answer 37

ESR and C-reactive protein

Question 38

Factors that increase the risk of developing, or perpetuating long-term disability and work loss associated with LBP

Answer 38

yellow flags

Question 39

On the FABQ what is a "high fear" on the activity subscale and a "high fear" on the work subscale?

Answer 39

- activity, 24 | - work, 42

Question 40

A high baseline FABQ physical activity subscale can be correlated with what after 6 months

Answer 40

a higher disability score

Question 41

There is no correlation between the baseline FABQ physical activity scale and 6-month disability, only if patients receieved what?

Answer 41

fear-avoidance based treatment

Question 42

What interventions (4) can be matched to stage 1: symptom modulation of the TBC level 2

Answer 42

- specific exercise/movement - mobilization/manipulation - traction - active rest

Question 43

What interventions (3) can be matched with stage 2: movement control of the TBC level 2

Answer 43

- movement control exercises - flexibility deficits (neural, soft tissue, jt) - stability

Question 44

What interventions (3) can be matched to stage 3: functional optimization of the TBC level2

Answer 44

- strength/coordination - endurance - work/sport specific

Question 45

According to CPGs diagnosis/classification, LBP with mobility deficits should have which type of interventions

Answer 45

manual therapy and exercise

Question 46

According to the CPGs diagnosis/classification, LBP with movement coordination impairments needs what type of interventions

Answer 46

stabilization exercises

Question 47

According to the CPGs diagnosis/classification, LBP with related LE pain or with radiating pain require which interventions

Answer 47

centralization and directional preference ex (flexion, extension, lateral shift, traction)

Question 48

If a patient centralize with 2 or more movements in the same direction OR centralizes with movement in one direction and peripheralize with an opposite movement which classification would they go under?

Answer 48

specific exercise classification

Question 49

If the patient has a duration of sx <16 days AND NO sx distal to the knee what classification would they fall under?

Answer 49

manipulation classification

Question 50

If the pt has 3 or more of the 4 things listed below which classification would they fall under? 1. avg SLR ROM > 91 deg 2. (+) prone instability test 3. (+) aberrant movement 4. Age < 40 years

Answer 50

stabilization classification

Question 51

If the patient peripheralizes with extension movement OR has a (+) crossed SLR test which classification would they fall under?

Answer 51

Traction classification

Question 52

What are 3 factors that favor manipulation as an intervention?

Answer 52

- hypomobility with spring testing - low FABQ scores (<19) - hip IR ROM > 35 deg

Question 53

What are 4 factors against doing manipulations for an intervention?

Answer 53

- sx below the knee - increased episode frequency - peripheralization with motion testing - no pain with spring testing

Question 54

What are the 3 factors that favor stabilization as a intervention for pt?

Answer 54

- hypermobility with spring testing - increasing episode frequency - 3 or more prior episodes

Question 55

What are the 2 factors that are against stabilization as an intervention?

Answer 55

- discrepancy in SLR ROM (>10 deg) | - Low FABQ scores (<9)

Question 56

Name 3 of the factors for favoring specific exercises as a intervention

Answer 56

- directional preference for extension or flexion - centralization with motion testing - peripheralization in direction opposite centralization

Question 57

Name the 2 factors that are against the use of specific exercise as an intervention

Answer 57

- low back pain (no distal dx) | - status quo with all movements

Question 58

What is the 1 major factor that favors traction as an intervention

Answer 58

peripheralization of sx with no ability to centralize with movement

Question 59

Name the 2 factors that are against using traction as an intervention

Answer 59

- LBP (no distal sx) | - no sign of nerve root compression