Vincent Dewitte1, Robby De Pauw2, Kayleigh De Meulemeester3, Wim Peersman4, Lieven Danneels5, Katie Bouche6, Arne Roets7, Barbara Cagnie8. 1. Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185 (3B3), 9000 Ghent, Belgium. Electronic address: Vincent.Dewitte@UGent.be. 2. Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185 (3B3), 9000 Ghent, Belgium. Electronic address: Robby.DePauw@UGent.be. 3. Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185 (3B3), 9000 Ghent, Belgium. Electronic address: Kayleigh.DeMeulemeester@UGent.be. 4. Department of Family Medicine and Primary Health Care, Ghent University, De Pintelaan 185 (6K3), 9000 Ghent, Belgium. Electronic address: Wim.Peersman@UGent.be. 5. Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185 (3B3), 9000 Ghent, Belgium. Electronic address: Lieven.Danneels@UGent.be. 6. Centre for Musculoskeletal and Neurological Rehabilitation, Ghent University Hospital, De Pintelaan 185 (K7), 9000 Ghent, Belgium. Electronic address: Katie.bouche@uzgent.be. 7. Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium. Electronic address: Arne.Roets@UGent.be. 8. Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185 (3B3), 9000 Ghent, Belgium. Electronic address: Barbara.Cagnie@UGent.be.
Abstract
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.
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 LBPpatients. 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 LBPpatients 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.
Authors: Muath A Shraim; Kathleen A Sluka; Michele Sterling; Lars Arendt-Nielsen; Charles Argoff; Karl S Bagraith; Ralf Baron; Helena Brisby; Daniel B Carr; Ruth L Chimenti; Carol A Courtney; Michele Curatolo; Beth D Darnall; Jon J Ford; Thomas Graven-Nielsen; Melissa C Kolski; Eva Kosek; Richard E Liebano; Shannon L Merkle; Romy Parker; Felipe J J Reis; Keith Smart; Rob J E M Smeets; Peter Svensson; Bronwyn L Thompson; Rolf-Detlef Treede; Takahiro Ushida; Owen D Williamson; Paul W Hodges Journal: Pain Date: 2022-01-19 Impact factor: 7.926
Authors: Alisa L Dutmer; Remko Soer; André P Wolff; Michiel F Reneman; Maarten H Coppes; Henrica R Schiphorst Preuper Journal: Eur Spine J Date: 2022-01-19 Impact factor: 3.134
Authors: Miriam Frenken; Sven Nebelung; Christoph Schleich; Anja Müller-Lutz; Karl Ludger Radke; Benedikt Kamp; Matthias Boschheidgen; Lena Wollschläger; Bernd Bittersohl; Gerald Antoch; Markus R Konieczny; Daniel B Abrar Journal: Diagnostics (Basel) Date: 2021-02-26
Authors: Mateusz Kozinoga; Łukasz Stoliński; Krzysztof Korbel; Katarzyna Politarczyk; Piotr Janusz; Tomasz Kotwicki Journal: J Clin Med Date: 2022-02-25 Impact factor: 4.241
Authors: Christopher A Gilmore; Mehul J Desai; Thomas J Hopkins; Sean Li; Michael J DePalma; Timothy R Deer; Warren Grace; Abram H Burgher; Puneet K Sayal; Kasra Amirdelfan; Steven P Cohen; Meredith J McGee; Joseph W Boggs Journal: Pain Pract Date: 2021-07-27 Impact factor: 3.079