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Utilizing Clinical Practice Guidelines for Treatment of Low Back Pain: Summary
Interpreting Strength of Recommendations Letter Grade Grade of
Level of Obligation
Recommendation Strength of Evidence
A Strong evidence
Multiple level I-II studies support the recommendation. Must include at least level I study
"Should"
B
Moderate evidence A single level I study or several level II studies support the recommendation
"May"
C
Weak evidence
A single level II study supports the recommendation
"Can"
D Conflicting or no evidence
High level studies disagree with respect to their conclusions to provide no evidence of benefit
"Should Not"
○ 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
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
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