The Use of a Classification Approach to Identify Subgroups of Patients With Acute Low Back Pain
SpinePublished 1 January 2000
Julie M. Fritz, Steven Z. George
Citations195
SJR quartileQ1
SJR score1.22
SNIP1.48
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Reaching a consensus regarding relevant patient subgroups requires data on the reliability and validity of existing classification systems, and further work is required to validate improvement in treatment outcomes using a classification approach.
Abstract
Reaching a consensus regarding relevant patient subgroups requires data on the reliability and validity of existing classification systems. Further work is required to validate improvement in treatment outcomes using a classification approach.
Keywords
Decision SciencesMedicineEconomics, Econometrics and Finance
BiometricsThe Measurement of Observer Agreement for Categorical Data
78,934 Citations1977J. Richard Landis, Gary G. Koch
A general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies is presented and tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interob server agreement are developed as generalized kappa-type statistics.
Annals of the Rheumatic DiseasesArticular mobility in an African population.
1,726 Citations1973Peter Beighton, Louis Solomon +1 more
The results of this investigation were the study of various bone and joint conditions, but the survey also provided an excellent opportunity for the measurement of the range of joint movements in a large number of individuals and for the assessment of the influence of age, sex, and somatotype on their articular mobility.
SpineEvaluation of Specific Stabilizing Exercise in the Treatment of Chronic Low Back Pain With Radiologic Diagnosis of Spondylolysis or Spondylolisthesis
1,096 Citations1997Peter O’Sullivan, Grad Dip Manip Phyty +2 more
A "specific exercise" treatment approach appears more effective than other commonly prescribed conservative treatment programs in patients with chronically symptomatic spondylolysis or spondYLolisthesis.
SpineConservative Treatment of Acute and Chronic Nonspecific Low Back Pain
988 Citations1997Maurits W. van Tulder, Bart W. Koes +1 more
The quality of the design, execution, and reporting of randomized controlled trials should be improved, to establish strong evidence for the effectiveness of the various therapeutic interventions for acute and chronic low back pain.
Clinical Orthopaedics and Related ResearchInstability of the Lumbar Spine
733 Citations1982W. H. Kirkaldy-Willis, H. F. Farfan
It is convenient to divide the spectrum of clinical manifestation of degenerative change seen in the lumbar spine into three stages: temporary dysfunction; (2) unstable phase; and (3) stabilization.
New England Journal of MedicineA Comparison of Physical Therapy, Chiropractic Manipulation, and Provision of an Educational Booklet for the Treatment of Patients with Low Back Pain
616 Citations1998Daniel C. Cherkin, Richard A. Deyo +3 more
For patients with low back pain, the McKenzie method of physical therapy and chiropractic manipulation had similar effects and costs, and patients receiving these treatments had only marginally better outcomes than those receiving the minimal intervention of an educational booklet.
Physical TherapyA Treatment-Based Classification Approach to Low Back Syndrome: Identifying and Staging Patients for Conservative Treatment
514 Citations1995Anthony Delitto, Richard E. Erhard +1 more
A treatment-based classification approach to the conservative management of low back syndrome is presented, with specific algorithms and decision rules as well as examples presented.
Clinical Orthopaedics and Related ResearchRecognizing Specific Characteristics of Nonspecific Low Back Pain
458 Citations1987Thomas N. Bernard, W. H. Kirkaldy-Willis
A retrospective review of 1293 cases of low back pain treated over a 12-year period revealed that sacroiliac joint syndrome and posterior joint syndromes were the most common referred-pain syndrome, whereas herniated nucleus pulposus and lateral spinal stenosis were themost common nerve root compression lesions.
SpineObjective Clinical Evaluation of Physical Impairment in Chronic Low Back Pain
415 Citations1992Gordon Waddell, Douglas Somerville +2 more
The aim of this study was to develop a method of clinical evaluation suitable for routine use, and to consider the relationship between pain, disability, and physical impairment in patients with chronic low back pain.
SpineStudying the Natural History of Back Pain
401 Citations1994Michael Von Korff
Improved information on the natural history of back pain is needed to enable doctors and their patients to understand the likely course ofBack pain and to evaluate whether alternative interventions are preferred over self care or watchful waiting.
Physical TherapyLow Back Exercises: Evidence for Improving Exercise Regimens
349 Citations1998Stuart M. McGill
Some specific exercises are described that have been shown to challenge muscle and enhance performance but that are performed in such a way as to minimize loading of the spine to reduce the risk of injury exacerbation.
Physical TherapyManaging Low Back Pain: Attitudes and Treatment Preferences of Physical Therapists
307 Citations1994Michele C. Battié, Daniel C. Cherkin +3 more
There were significant variations among therapists in private practice, hospital-operated, and health maintenance organization settings with respect to treatment preferences, willingness to take advantage of the placebo effect, and mean number of visits for patients with back pain.
SpinePredicting Poor Outcomes for Back Pain Seen in Primary Care Using Patientsʼ Own Criteria
301 Citations1996Daniel C. Cherkin, Richard A. Deyo +2 more
The proportion of primary care patients with back pain who have poor outcomes appears to be higher than generally recognized and ways of improving how primary care responds to patients with persisting pain should be investigated.
Arthritis & RheumatismDegenerative lumbar spinal stenosis diagnostic value of the history and physical examination
275 Citations1995Jeffrey N. Katz, Marianne Dalgas +6 more
Specific history and physical examination findings are useful in the diagnosis of LSS and should be ascertained routinely in older patients with low back pain.
BMJRandomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up
234 Citations1995T W Meade, Sandra Dyer +2 more
The results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractor derive more benefit and long term satisfaction than those treating by hospitals.
Spine1989 Volvo Award in Clinical Sciences: Reproducibility of Physical Signs in Low-Back Pain
232 Citations1989P. F. McCombe, Jeremy Fairbank +2 more
The reproducibility between observers of physical signs in patients with low-back pain was investigated and signs of root tension showed better agreement when qualified with a description of where the pain was experienced.
Physical TherapyThe Efficacy of Traction for Back and Neck Pain: A Systematic, Blinded Review of Randomized Clinical Trial Methods
224 Citations1995Geert J. van der Heijden, Anna JHM Beurskens +4 more
There are no clear indications, however, that traction is an ineffective therapy for back and neck pain, and much more attention should be paid to proper design and conduct, as well as to clear descriptions of crucial methodological features and results.
Physical TherapyReliability of Physical Examination Items Used for Classification of Patients With Low Back Pain
218 Citations1998Linda R. Van Dillen, Shirley A. Sahrmann +5 more
Reliability of physical examination items used for classification of patients with low back pain suggests that experienced therapist who had trained together were able to agree on the results of examinations and obtain an acceptable level of reliability.
Archives of Physical Medicine and RehabilitationLumbar spinal stenosis: A review of current concepts in evaluation, management, and outcome measurements
204 Citations1998Julie M. Fritz, Anthony Delitto +2 more
The present level of understanding of lumbar spinal stenosis is deficient in many areas, including differential diagnosis, treatment, and outcome assessment, and future research should address these deficits to improve the management of patients with this condition.
Physical TherapyRelative Effectiveness of an Extension Program and a Combined Program of Manipulation and Flexion and Extension Exercises in Patients With Acute Low Back Syndrome
196 Citations1994Richard E. Erhard, Anthony Delitto +1 more
In this category of patients with low back pain, the use of manipulation as an adjunct to an ongoing exercise program appears to be warranted.
SpineThe Prognostic Consequences in the Making of the Initial Medical Diagnosis of Work-Related Back Injuries
190 Citations1995Lucien Abenhaim, Michel Rossignol +4 more
The physician's initial diagnosis was highly associated with the risk of chronicity, involving the nature of the underlying lesion as well as the impact of the diagnosis “label” on the worker and on the physician-patient relationship.
PubMedCentralization phenomenon. Its usefulness in evaluating and treating referred pain.
186 Citations1990Ronald Donelson, Gustavo Silva +1 more
SpineA Report From the Second International Forum for Primary Care Research on Low Back Pain
172 Citations1998Jeffrey Borkan, Bart W. Koes +2 more
Methodologic advances, the enlistment of new techniques and disciplines, and redirected research efforts may facilitate progress in the diagnosis and treatment of lower back pain.
SpineInterexaminer Reliability in Physical Examination of Patients With Low Back Pain
169 Citations1997Lars‐Erik Strender, Anneli Sjöblom +3 more
The reliability was acceptable for a number of clinical tests that are used in the evaluation of patients with low back pain and the results suggest that clinical tests should be standardized to a much higher degree than they are today.
SpineCentralization Phenomenon
163 Citations1990Ronald Donelson, GREGORY SILVA +1 more
In patients with low-back and radiating leg pain, nonoccurrence of centralization accurately predicts poor treatment outcome and was a helpful early predictor of the need for surgical treatment.
PubMedPsychosocial predictors of disability in patients with low back pain.
157 Citations1988Richard A. Deyo, Andrew K. Diehl
Predictors of future function, employment, and medical utilization were drawn from 21 clinical, demographic, and psychosocial variables using multivariate techniques to support the importance of education and self-rated health as correlates of back related disability.
Physical TherapyChanges in Innominate Tilt After Manipulation of the Sacroiliac Joint in Patients with Low Back Pain
155 Citations1988Michael T. Cibulka, Anthony Delitto +1 more
The results indicate that SIJD can be identified reliably in patients with LBP and that a manipulative procedure purported to be specific to the sacroiliac joint changes innominate tilt bilaterally and in opposite directions.
SpineWhy Has the Search for Causes of Low Back Pain Largely Been Nonconclusive?
141 Citations1997Charlotte Leboeuf‐Yde, Jens Lauritsen +1 more
There was only one statistically significant strong association between the potential risk indicators and the nonspecific definition of low backPain, but several emerged when the low back pain group was split into subgroups.
SpineConservative Treatment of Acute Low-Back Pain
136 Citations1990Radisav Stankovic, O. Johnell
It is demonstrated that the McKenzie method of treatment for patients with acute low-back pain was superior for five out of seven variables studied, and the only variables that did not show any statistically significant differences were sick-leave during recurring episodes of pain and patients' ability to self-help.
Physical TherapyClassification and Low Back Pain: A Review of the Literature and Critical Analysis of Selected Systems
135 Citations1998Daniel L. Riddle
The analysis suggests that future research should address the usefulness of existing classification systems as well as the development of new classification systems designed using commonly accepted measurement principles.
Physical TherapyThe Relationship Between Nonorganic Signs and Centralization of Symptoms in the Prediction of Return to Work for Patients With Low Back Pain
126 Citations1997Rob Karas, Greg McIntosh +3 more
A high Waddell score appears to be the best predictor of outcome, as indicated by return to work at a 6-month follow-up.
SpineMethodologic Issues in Low Back Pain Research in Primary Care
123 Citations1998L.M. Bouter, Maurits W. van Tulder +1 more
This work discusses some important methodologic challenges in low back pain research in primary care, and methodologic problems related to four research issues will be discussed: study designs, definition of low backPain, determinants ofLow back pain, and outcome assessment.
SpineIntertester Reliability of McKenzieʼs Classifications of the Syndrome Types Present in Patients with Low Back Pain
108 Citations1993Daniel L. Riddle, Jules M Rothstein
The results suggest that assessments of the syndrome present in patients; with low back pain appear to be unreliable when using the McKenzie system.
SpineThe Nature of Instability
104 Citations1984H. F. Farfan, Serge Gracovetsky
(Clinical) instability is that (symptomatic) condition where, in the absence of new injury, a physiologic load induces abnormally large deformations at the intervertebral joint.
Physical TherapyPhysical Therapy Diagnosis: Role and Function
93 Citations1989Steven J. Rose
The current political-legal aspects of this issue mandate that the profession clearly communicate that the intention of the physical therapy diagnosis is not to infringe on the practice of others or to assume roles that are beyond the scope of the authors' education and training.
SpineConservative Treatment of Acute Low Back Pain
88 Citations1995Radisav Stankovic, Olof Johnell
The results showed thatSubjects who received treatment according to the McKenzie principle 5 years earlier had significantly less recurrences of pain and fewer were on sick leave compared with the subjects who received education in mini back school.
Physical TherapyA Physical Therapy Model for the Treatment of Low Back Pain
79 Citations1992Carl DeRosa, James A. Porterfield
The magnitude of the low back pain problem is discussed, the various treatment methods are outlined, and a strategy to classify and standardize the treatment of the patient who has low backPain is developed.
SpineBack Pain and Trunk List
44 Citations1986Richard W. Porter, C. Glenn Miller
An association of trunk list with back pain was recorded in 100 patients, 5.6% of those attending a back pain clinic, and there is some evidence that the side of the list may be related to hand or leg dominance.
Orthopedic Clinics of North AmericaThe Syndromes of Low Back Disease
31 Citations1983Vert Mooney
The details of the various clinical syndromes are presented in the text, with further expansion by the various references.
SpineA Dynamic Approach to Spinal Instability
26 Citations1997M Ogon, Benjamin R. Bender +5 more
The results suggest that a small jerk is a normal component of fast intersegmental motion and a certain magnitude and location in an intact functional spinal unit, whereas both of the parameters describing the jerk are sensitive to component instability.
Physical TherapyAssociation Between Direction of Lateral Lumbar Shift, Movement Tests, and Side of Symptoms in Patients with Low Back Pain Syndrome
22 Citations1990Janet A Tenhula, Steven J. Rose +1 more
The clinical usefulness of the side-bending movement test for determining the presence and direction of an LLS is confirmed and is necessary in certain physical therapy management approaches.
BMJManipulative therapy and physiotherapy for persistent back and neck complaints.
6 Citations1992P. Brien
The survey was too poorly constructed to reflect adequately what manipulative physiotherapists of today are capable of and the effective treatment patients should receive.
