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Utilizing Clinical Practice Guidelines for Treatment of Low Back Pain: Summary
Clinicians who use CPGs: • Physical therapists and physical therapist assistants • Occupational therapists and occupational therapist assistants • Athletic trainers • Insurance personnel • Physicians and associated practitioners: ○ PA ○ NP ○ Nurses • Clients : They have access to CPGs if they desire Gaps in Knowledge Throughout the CPGs, the authors identify where more research would be beneficial, under the subhead “Gaps in Knowledge.” They identify the need for level 1 RTCs and other recommendations to further strengthen the CPGs. • Acute LPB Gaps in CPGs : ○ Exercise : Movement control—trunk mobility/ aerobic exercise/multimodal exercise ○ Manual and other directed therapies: Neural tissue mobilization, dry needling, traction ○ Classification systems: ■ Cognitive functional therapy ■ Prognostic risk stratification ■ Pathoanatomic-based classification ■ Movement system impairment ○ Client education : Pain neuroscience education
• Chronic LBP Gaps in CPGs : ○ Exercise : Comparisons of different approaches, optimal dosing parameters, targeted delivery ○ Manual and other directed therapies : ■ Comparisons of manual therapy and active treatments ■ Value of manual therapy in multimodal approaches ○ Classification systems : Direct comparisons of different classification systems ○ Client education : To be determined CLASSIFYING LOW BACK PAIN (LBP) Not all clients have the same etiology, history, presentation, and functional capabilities despite the same diagnosis of LBP (even if the diagnosis is extremely specific, e.g., “herniated nucleus pulposus (HNP) of L4–L5 with left LE radiculopathy”). Signs, symptoms, and clinical presentations will be similar. However, individual client impairments, activity limitations, and participation will vary. Other factors play a role, such as the environment, occupational, and other personal factors. This indicates the rationale and basis of the ICF model. A specific cause cannot be identified for around 85% to 90% of low back pain cases, which are described as nonspecific low back pain (NSLBP).
ICF MODEL
Health Condition (Disorder or disease)
Body Functions and Structures (Impairments)
Participation (Restriction)
Activities (Limitations)
Environmental Factors
Personal Factors
The ICF model is the World Health Organization’s (WHO) framework for measuring health and disability at both individual and population levels.
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