Clinical classification criteria for nonspecific low back pain: A Delphi-survey of clinical experts

被引:28
作者
Dewitte, Vincent [1 ]
De Pauw, Robby [1 ]
De Meulemeester, Kayleigh [1 ]
Peersman, Wim [2 ]
Danneels, Lieven [1 ]
Bouche, Katie [3 ]
Roets, Arne [4 ]
Cagnie, Barbara [1 ]
机构
[1] Univ Ghent, Dept Rehabil Sci & Physiotherapy, De Pintelaan 185 3B3, B-9000 Ghent, Belgium
[2] Univ Ghent, Dept Family Med & Primary Hlth Care, De Pintelaan 185 6K3, B-9000 Ghent, Belgium
[3] Ghent Univ Hosp, Ctr Musculoskeletal & Neurol Rehabil, De Pintelaan 185 K7, B-9000 Ghent, Belgium
[4] Univ Ghent, Dept Dev Personal & Social Psychol, Henri Dunantlaan 2, B-9000 Ghent, Belgium
关键词
Consensus; Low back pain; Clinical reasoning; Clinical patterns; MECHANISMS-BASED CLASSIFICATIONS; INJECTION ARTHROGRAPHY TECHNIQUE; MYOFASCIAL TRIGGER POINTS; NEUROPATHIC PAIN; CENTRAL SENSITIZATION; MUSCULOSKELETAL PAIN; SUBGROUPING PATIENTS; PRIMARY-CARE; SYMPTOMS; NECK PAIN;
D O I
10.1016/j.msksp.2018.01.002
中图分类号
R49 [康复医学];
学科分类号
100215 ;
摘要
Background: Nonspecific low back pain (NSLBP) is a common problem. Attempts have been made to classify NSLBP patients into homogenous subgroups. Classification systems based on identifying the underlying mechanism( s) driving the disorder are clinically useful to guide specific interventions. Objective: To establish consensus among experts regarding clinical criteria suggestive of a dominance of 'articular', 'myofascial', 'neural', 'central', and 'sensorimotor control' dysfunction patterns (DPs) in NSLBP patients. Study design: A 2-phase sequential design of a focus group and Delphi-study. Methods: A focus group with 10 academic experts was organized to elaborate on the different DPs discernible in LBP patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 DPs resulting from the focus group. Results: Fifteen musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating LBP patients completed the Delphi-survey. Respectively, 34 (response rate, 100.0%), 20 (58.8%) and 15 (44.12%) respondents replied to rounds 1, 2 and 3. Twenty-two 'articular', 20 'myofascial', 21 'neural', 18 'central' and 11 'sensorimotor control' criteria reached a predefined >= 80% consensus level. For example, after round 2, 85.0% of the Delphi-experts agreed to identify 'referred pain below the knee' as a subjective examination criterion suggestive for a predominant 'neural DP'. Conclusion: These indicators suggestive of a clinical dominance of the proposed DPs could help clinicians to assess and diagnose NSLBP patients. Future reliability and validity testing is needed to determine how these criteria may help to improve physical therapy outcome for NSLBP patients.
引用
收藏
页码:66 / 76
页数:11
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