M2 Knowledge Check Qs

Question 1

Primary purpose for performing medical screen on pt with LBP (3)

Answer 1

• identify clinical behavior that warrants immediate medical workup
• identify clinical behavior that warrants non-urgent yet necessary medical consultation
• identify co-morbid medical conditions that will impact current episode of care for LBP

Question 2

Prevalence/incident rates of significant Red Flag behaviors

Answer 2

3-8% incident rate of serious pathology associated with LBP

Question 3

What is the leading red flag condition that will present in the clinic for evaluation of LBP?

Answer 3

pathological/insufficiency spinal fracture

Question 4

Clinical patter of pathological/insufficiency spinal fracture

Answer 4

older, limited ability to stand or walk, history of corticosteroid medication

Question 5

Critical responsibilities of the PSP/first contact practitioner managing pts with LBP at initial encounter

Answer 5

• medical status/hx
• identify confounding medical/psych variables
• establish neurological baseline
• track neurological status

Question 6

Neuropathic classification LBP signs/symptoms

Answer 6

• LBP with:
• leg pain
• sensory and reflex changes
• muscle weakness
• altered neurodynamics

Question 7

Nociplastic LBP classification signs/symptoms

Answer 7

Nociplastic dominant will present with altered behavioral characteristics, attributed to altered cognitive processing (poor self-efficacy, depressive sx, kenesiophobia)

Question 8

Nociceptive LBP classification signs/symptoms

Answer 8

can be either mechanical or inflammatory, but won’t have corresponding clinical signs of peripheral neurological involvement

Question 9

psycho-emotional LBP classification signs/symptoms

Answer 9

underlying psychological condition that will require specific evaluation and management

Question 10

According to Dr. Chris Standeart, ESI has best chance of success and should be considered when:

Answer 10

the individual with acute, subacute leg pain that is not responding favorably to mechanical interventions

Question 11

Primary reason for performing spinal surgery

Answer 11

• reduce/eliminate the threat posed to neurological structures.
• MYOTOMAL WEAKNESS is the most significant clinical sign of nerve root injury/dysfunction
• pts with progressive or persistent neurological involvement despite receiving appropriate non-surgical care likely will require surgical decompression/removal for recovery to occur

Question 12

p-value implying statistical SIGNIFICANCE

Answer 12

p-value LESS than 0.05 is statistically significant

Question 13

p-value implying statistical IN-significance

Answer 13

p-value GREATER than 0.05 is statistically insignificant

Question 14

Summary of the TBC Movement Control Approach

Answer 14

human movement is a complex dynamic that depends on interplay of LOCAL MOBILITY needs, GLOBAL STABILITY needs, which are impacted by BOTH cognitive behavioral and socio-occupational factors

Question 15

Type of clinical tests that can help clinicians rule OUT conditions

Answer 15

tests with HIGH sensitivity

SNOUT

Question 16

Type of clinical tests that can help clinicians rule IN conditions

Answer 16

tests with HIGH specificity

SPIN

Question 17

Clinical tests to help identify lumbar spondylolisthesis, according to Ahn and Jhun

Answer 17

• Low Midline Sill Sign

- Interspinous Gap Test

Question 18

Primary finding of the Pilz et.al article

Answer 18

Using trunk performance ratios, they were able to demonstrate appreciable difference in age-matched individuals with and without LBP.

Question 19

Lumbar disc/discogenic LBP typical characteristics:

Answer 19

• acute antalgia
• difficulty assuming lordosis w sit to stand
• painful obstruction to lumbar extension (reduces with repeated/sustained ext)
• centralization of distal symptoms that are present

Question 20

Lumbar spinal stenosis typical characteristics:

Answer 20

• 48+yrs

- predominantly LE sx that are WORSE WITH WALKING

Question 21

CDR - Clinical Diagnostic Rule for patients with sacroiliac joint pain

Answer 21

• lack of centralization and reproduction of low back pain

WITH 3/5 positive tests/ Laslett Cluster:

• distraction test
• compression test
• thigh thrust
• Gaenslen’s test
• sacral thrust

Question 22

CDR - Clinical Diagnostic Rule for disc herniation with nerve root involvement by Petersen, Laslett, Juhl:

Answer 22

• Positive SLR plus 3/4:
• dermatomal P in correspondence with a nerve root
• corresponding sensory deficit
• motor weakness/decreased DTR

Question 23

CDR - Clinical Diagnostic Rule for spinal stenosis:

Answer 23

• 3/5 of the following:
• age 48+
• b/l LE symptoms
• leg P worse than back P
• P during standing/walking that is relieved with sitting

Question 24

Capsular pattern of loss of hip ROM:

Answer 24

• significant loss of passive Flexion, abduction and internal rotation, slight loss of passive Extension, little or no loss of passive external rotation

Question 25

MC psychological factors that can impact risk for spine pain chronicity:

Answer 25

• anxiety
• situational depression
• disability
• passive coping
• low self-efficacy

Question 26

What is graded exposure for LBP patients?

Answer 26

therapeutic approach most appropriate with nocioplastic or nociceptive sensitization, where a functional activity identified as painful is REPEATED, creating repeated exposure to the stimulus to decrease the perception of subsequent stimulation AKA habituation

• rather than activating perfipheral nociceptors, it DECREASES PERIPHERAL SENSITIZATION
• NOT appropriate for acute inflammatory pain or mechanical nociceptive pain

Question 27

Pain neuroscience education facilitates achievement of therapeutic goals by:

Answer 27

decreasing the belief that pain poses a threat to their health and wellbeing

Question 28

Best way to improve patient engagement for patients that do not regularly exercise

Answer 28

utilize motivational interviewing to elicit motivation for behavior change