Lumbar Screening

Question 1

Components to Examination/Evaluation

Answer 1

• Component 1: Medical Screening
• Subjective and Objective red flags and yellow flag assessment
• Component 2: Differentiation of impairments, activity and participation restrictions associated with health condition
  – Identify “source of pain”
  – Identify “patterns of symptoms”
• Component 3: Diagnosis of severity, irritability, and stability of condition
• Component 4: Match intervention strategies based on findings

Question 2

What fundamental question must be awnser for a patient when first examining?

Answer 2

Is PT appropriate for this patient?

If YES – 2 options:
1. Treat appropriately
2. Treat and refer (non-urgent)

If NO – 2 options:
1. Refer back to MD (urgent or non-urgent)
2. No treatment (inappropriate to treat)

Question 3

Medical Screening

Answer 3

• The process of ruling in/out the presence of red/yellow flags prior to treatment.
• A “Systems Check” where abnormal findings require a more in depth look
• If no concerns we move on, if concerns we DIG DEEPER

Question 4

Differential Dx:

Answer 4

Process of integrating and evaluating data obtained from the evaluation and distinguishing the difference between different health conditions.

Two kinds:
Differential diagnosis of medical conditions?
Differential diagnosis of physical therapy conditions?

Question 5

What are the 4 pre-screening tools often used?

Answer 5

1. Medical Screening Questionnaire / Past Medical History
2. Ransford Pain Diagram / Visual Analog Pain Scale/NPR
3. Functional Outcome Measures
   – e.g. Oswestry Disability Index (ODI) – most common for back pain
4. Psychological Risk Factors (yellow flags)
   – e.g. Fear Avoidance and Beliefs Work and Physical Activity Questionnaire, Pain catastrophizing scale, Tampa Scale of Kinesiophobia, STarT screening tool

Question 6

What is the most commonly used pre-screening tool for LBP?

Answer 6

Oswestry Disability Index

Question 7

Yellow Flags – Psychosocial risk factors for persistent pain

Answer 7

These may affect prognosis and focus of interventions:
* Depression
* Fear avoidance beliefs
* Pain catastrophizing
* Psychological distress

Question 8

What two questions must you ask in regards to depression?

Answer 8

• During the past month, have you often been bothered by feeling down, depressed, or hopeless?
• During the past month, have you often been bothered by little interest or pleasure in doing things?
• No to both, depression highly unlikely
• Yes to either may require further follow up

Question 9

What is the greatest negative factor on prognosis?

Answer 9

• Fear-avoidance beliefs

Question 10

The FABQ will be able to tell you…

Answer 10

who is at risk for prolonged disability

Question 11

What scores on the FABQPA and FABQW are concerning?

Answer 11

• FABQPA: Greater than 14 (likely to avoid activity)
• FABQW: Greater than 29 (predictive disability at 6 months)

Question 12

Tampa Scale of Kinesiophobia tells you…

Answer 12

someones fear of movement

Question 13

What Pain Catastrophizing Scores are concerning? What can it predict?

Answer 13

• Predictive of disability at 6-12 months
• Moderate Risk: Greater than 20
• High Risk: Greater than 30

Question 14

What is the STarT Back tool used for?

Answer 14

• Risk stratification to low, medium, or high risk of poor outcomes (persistent pain)
• Those in the high risk group should have more psychosocial and pain management aspects incorporated in treatment