Article

Several studies have investigated criteria for classifying patients
with low back pain (LBP) into treatment-based subgroups.
A comprehensive
algorithm was created to translate these criteria into a clinical decision-making
guide. This study investigated the translation of the individual
subgroup criteria into a comprehensive algorithm by studying the prevalence of
patients meeting the criteria for each treatment subgroup and the reliability of
the classification. This was a cross-sectional, observational study.
METHODS: Two hundred fifty patients with acute or subacute LBP were recruited
from the United States and Australia to participate in the study. Trained
physical therapists performed standardized assessments on all participants. The
researchers used these findings to classify participants into subgroups.
Thirty-one participants were reassessed to determine interrater reliability of
the algorithm decision. RESULTS: Based on individual subgroup criteria, 25.2%
(95% confidence interval [CI]=19.8%-30.6%) of the participants did not meet the
criteria for any subgroup, 49.6% (95% CI=43.4%-55.8%) of the participants met the
criteria for only one subgroup, and 25.2% (95% CI=19.8%-30.6%) of the
participants met the criteria for more than one subgroup. The most common
combination of subgroups was manipulation + specific exercise (68.4% of the
participants who met the criteria for 2 subgroups). Reliability of the algorithm
decision was moderate (kappa=0.52, 95% CI=0.27-0.77, percentage of
agreement=67%). LIMITATIONS: Due to a relatively small patient sample,
reliability estimates are somewhat imprecise. CONCLUSIONS: These findings provide
important clinical data to guide future research and revisions to the algorithm.
The finding that 25% of the participants met the criteria for more than one
subgroup has important implications for the sequencing of treatments in the
algorithm. Likewise, the finding that 25% of the participants did not meet the
criteria for any subgroup provides important information regarding potential
revisions to the algorithm's bottom table (which guides unclear classifications).
Reliability of the algorithm is sufficient for clinical use.

Langue : ANGLAIS