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TBC for LBP
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TBC for LBP - November 9, 2005 12:17:00 PM
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MPTSTUDENT
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Does anyone use the TBC system (delitto et al) for treating patients with LBP? What are your opinions, experiances with it?
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Re: TBC for LBP - November 10, 2005 5:17:00 AM
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JLS_PT_OCS
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MPT-
I have the less-experienced PT students use it, as it can be a valuable template for clinical decisionmaking.
I think, since more recent research re:stabilization and manipulation have been around, that it probably could use an update.
I think most clinicians have these sorts of algorithms in their heads anyway, and when I read it, it made immediate sense to me. I think if you combine it with the manipulation CPR, the directional preference exercise research, and the proposed stabilization CPR, you have a pretty good framework for which to approach things in the clinic.
Personally, I manipulate more and traction less, but I think it's a useful guide.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: TBC for LBP - November 10, 2005 5:34:00 AM
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MPTSTUDENT
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Jason, thanks for your input. I really basically felt the same way in myself. It's a good place to start when integrated with more current stuff such as the manipulation CPR and the stabilization CPR which I just read yesterday. Is there anything else with it being worked on (e.g. a validation study like with the manipulation CPR)? Also, with the direction preference exercise research I have not read a whole lot of information on it yet. Are there any specific studies you could point me to to save me some time with lit. searching. Pretty busy time of year in school so any time saved is a plus. Thanks again.
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Re: TBC for LBP - November 10, 2005 5:47:00 AM
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JLS_PT_OCS
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15564907&query_hl=2
This is the best guide for the directional preference issue. I think Sahrmann has a useful theoretical approach for low back pain patients and their classification. I have not seen much in the way of outcomes, but it is classification-based, so it might be worth a look.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: TBC for LBP - November 10, 2005 9:57:00 AM
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ginger
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Jason et al, , could you please explain manipulation CPR, this abbreviation usually refers to cardio pulmonary resuscitation, so that makes no sense, also while you are at it, TBC. TVM, ( thanks very much ).
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The Grand Pediculator
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Re: TBC for LBP - November 10, 2005 10:13:00 AM
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SJBird55
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ginger - clinical prediction rule
I have no idea what TBC is. If it were GC, I'd know in a heartbeat... hint, hint... George someone? LOL
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Re: TBC for LBP - November 10, 2005 5:59:00 PM
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ginger
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TVM MA MCaaHNYTYaAYF
G
(thanks very much, much appreciated , merry christmas and a happy new year to you and all your family.)
Ginger
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The Grand Pediculator
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Re: TBC for LBP - November 10, 2005 9:47:00 PM
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Alex Brenner PT MPT OCS
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I think both studies have been great steps forward in PT research on how we approach and treat low back pain. In my opinion, these studies should be in the top drawer of your research cabinet. Both studies again point out that all low back pain is not the same and can not be lumped into the same group which is what much of the previous research in LBP has done.
The TBC article was presented to us when I was in PT school. As a new PT, with entry level skills, I found that this treatment approach was effective for treating LBP. I found it easier to sort my low back patients into different treatment groups as described in the above Delitto article rather than trying to palpate various "obliquities" and figure out that they had a "FRS right" etc. and treating that way (which is what I was originally taught in PT school).
The am interested to see if TBC systems will be researched for other difficult to treat pathology such as PFPS/non specific anterior knee pain.
Gingy, you have a strange sense of humor.
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Alex Brenner, PT, MPT, OCS
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Re: TBC for LBP - November 10, 2005 9:55:00 PM
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Alex Brenner PT MPT OCS
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I have electronic copies of both of the above mentioned articles. If you want them, please email me.
Army
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Re: TBC for LBP - November 11, 2005 3:01:00 AM
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Shill
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I for one, think that there are too many categories. I think that there should be two categories, centralizers, and non centralizers. Treatments applied would be similar to those effective tools that we know about.
Steve
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Re: TBC for LBP - November 11, 2005 2:22:00 PM
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Jeffre
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MPT and Jason,
I found this lumbar eval online. It says Delitto but not sure if he developed it. It uses exactly what you say: TBC but with CPR for both manip and stab. It looks like they ditched traction in favor of a Mckenzie style approach. It also adds a second eval/treatment for pts who score high on the FABQ. The only thing I would add is the SI cluster tests. Let me know what you guys think.
http://www.aptei.com/articles/index.jsp
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Re: TBC for LBP - November 12, 2005 6:47:00 AM
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certMDT
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A couple of thoughts on the classification posted above. First, I really like the idea of the algorithm - when I talked to Julie Fritz or John Childs, they seemed to deny the need for a top-down algorithm, as patients rarely had symptoms fitting multiple classifications. This decision to rule in or out one classification at a time makes much more sense to me, as does the Factors favoring/Factors against if the answers are not clear. I disagree with the first category, however, in which patients are taken out of this algorithm if the fear-avoidance is too high. Werneke has repeatedly shown that centralization is a stronger predictor of outcome than yellow flags/fear avoidance. I agree with Shill - determine the presence of centralization/directional preference first, and only if that is not present would one look to the other categories.
I wonder why in the classification above he takes out the 35 degrees of internal rotation? Seems arbitrary, considering all of the hard work Childs et al put into researching this. I would understand if he had used only the time frame and location of symptoms, at least that has been recognized as valid in a follow-up study.
Charlie
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Re: TBC for LBP - November 12, 2005 4:08:00 PM
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Jeffre
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Yeah I noticed that he takes out the IR criteria. Don't know why that is. Perhaps he thinks it is easier to get 3/5 or 4/5 without it. The second eval section caught me by surprise. It looks like he is saying that if the FABQ are high the best thing is just go get the pt moving and maybe try to break the pain cycle?
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"You are as well as your insurance company is willing to allow."
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Re: TBC for LBP - November 13, 2005 1:41:00 AM
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certMDT
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With regard to the FABQ, that appears to be exactly what he's saying. That doesn't appear reasonable at this point, considering what has been shown about the value of centralization, even in the presence of fear-avoidance beliefs:
Werneke MW, Hart DL. Centralization: association between repeated end-range pain responses and behavioral signs in patients with acute non-specific low back pain.
J Rehabil Med. 2005 Sep;37(5):286-90.
Werneke MW, Hart DL. Categorizing patients with occupational low back pain by use of the Quebec Task Force Classification system versus pain pattern classification procedures: discriminant and predictive validity.
Phys Ther. 2004 Mar;84(3):243-54.
Charlie
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Charles Sheets PT OCS Dip MDT
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