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RE: Classification-based treatment
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RE: Classification-based treatment - August 20, 2007 2:01:13 PM
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jesspt
Posts: 85
Joined: April 3, 2007
From: Illinois
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It sounds like you're referring to the McKenzie classification scheme? Is that a correct assumption?
Using Delitto's treatment based classification, I'm less concerned about mid vs. end range pain. I just use repeated motions to ascertain whether or not a patient's symptoms centralize.
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Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy
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RE: Classification-based treatment - August 20, 2007 3:02:07 PM
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proud
Posts: 944
Joined: March 22, 2006
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Shill, Jesse,
Thank you for the input. Actually, the discussion here is relevant to why I asked the question in the first place.
I, like Shill, tend to be a bit more investigative with centralization than most classification schemes I know. Delitto's asked the questions:
"does the patient centralize with at least two movements in the same direction(ie extension or flexion)
AND
" Does the patient centralize with a movemnt in one direction and peripheralize with an opposite movement"
I tend to complete a full McKenzie evaluation first. As centralization has good support as a prognostic indicator for recovery...why not complete a full evaluation in search of it?
Also, if symptoms are non-radicular and do not centralize. I would like to see some a scheme with neural tissue Tx( like the mulligan SLR or slump stretching as described by Cleland, Childs, Palmer, Eberhart). Perhaps this could be included in the manipualtion/mobilization category?
Anyway, just a few thoughts.
< Message edited by proud -- August 20, 2007 6:35:47 PM >
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RE: Classification-based treatment - August 20, 2007 3:17:58 PM
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jesspt
Posts: 85
Joined: April 3, 2007
From: Illinois
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I wonder if some of those patients who benefit from MWM SLR might be the very ones that Delitto currently puts in his traction category?
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Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy
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RE: Classification-based treatment - August 20, 2007 6:52:23 PM
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jesspt
Posts: 85
Joined: April 3, 2007
From: Illinois
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Yeah, that's the one. It's also the classification scheme that's used in the studies I posted earlier.
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Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy
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RE: Classification-based treatment - August 24, 2007 11:52:41 PM
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rwillcott
Posts: 435
Joined: March 20, 2006
From: Canada
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Proud,
I follow Delitto's classification system. Mainly because it has research to support it's effectiveness and it makes sense to me. I have had great success with this system.
Recently, Brennan et. al. (Spine, 2006) published an excellent RCT demonstrating the effectiveness of this system. They compared two groups of LBP patients with symptoms less than 90 days. One group was matched to their treatment sub-group and the other was unmatched. After 4 weeks, patients recieving matched treatments experienced greater short and long-term reductions in disability than those recieving unmatched treatments.
The take home message of this study was that non-specific LBP should not be viewed as a homogenous condition. Outcomes can be improved when subgrouping is used to guide treatment decision-making.
My opionion is that manual therapists who follow a pathoanatomical approach relying on motion palpation are treating LBP patients as a homogenous group. After months of grade 3-4 mobs of a unilateral flexion dysfunction of L4/L5 a patient finally gets better due to the natural course of healing. If the same patient was placed in the appropriate sub-group their level of disability would have improved within a much shorter period.
Rob
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