The treatment-based classification system for low back pain:

Updated with a prediction rule to identify responders to extension

exercises
Sponsored by the Orthopaedic Division

Date: February 3, 2010: 12-1pm EST

Speaker: Eric Parent

DESCRIPTION OF SESSION:

Patients with low back pain present with similar symptoms but form a heterogenous group based
on their response to treatment. Some patients are more likely than others to respond successfully
to specific interventions by physical therapists. Therapists and researchers agree that developing
classification systems to provide the right treatment to the right patient is a priority with the
potential to improve patients outcomes and clarify which interventions are most useful in patients
with low back pain. The treatment-based classification system has been developed by clinical
experts to guide the prescription of treatments for low back pain. In the last decade, research has
provided evidence to clarify the factors guiding the treatment prescription. Prediction rules have
been developed to identify patients with low back pain responding to manipulation, stabilization
exercises and traction but not for repeated movement exercises. Extension exercises are known
to benefit some, but not all, patients with low back pain (LBP). We recently developed a prediction
rule to guide clinicians in providing extension exericises to patients most likely to benefit.

Treatment based classification and prediction rule guiding treatment selection for patients with
low back pain is directly relevant to physical therapy. Low back pain accounts for nearly 50% of
outpatients physical therapy visits. Low back pain is associated with important disability and
costs. Physical therapists are trained to assess and offer treatments in the treatment-based
classification system proposed. The use of classification has been shown to lead to improved
patients outcomes. Providing therapists will an update on the research evidence available about
the classification system has the potential to lead to further practice improvements.

OBJECTIVES: Upon completion of this workshop participants will:

1. Understand the rationale behind the treatment-based classification system for patients
with low back pain;
2. Learn the clinical criteria predicting good treatment response to manipulation,
stabilization exercises, traction and specific repeated movement exercises among
patients with low back pain;
3. Understand the assessment of the response of patient with low back pain to repeated
movements guiding the classification of patients with low back pain responding to
extension exercises.

SPEAKER BIO:

Eric Parent
Dr. Parent’s clinical and research interests lie in the assessment and treatment of persons with
low back pain or scoliosis. In January 2008, he joined the department of Physical Therapy in the
Faculty of Rehabilitation Medicine with a joint appointment at the Glenrose Rehabilitation
Hospital. Dr. Parent’s Ph.D work focused on the development of quantitative measures of disc
bulging from MRI. In 2006-2007, he completed a CIHR sponsored post-doctoral fellowship with
Dr Julie Fritz, focused on continuing the development of a treatment-based classification of
patients with low back pain. Dr. Parent developed a preliminary prediction rule to identify patients
with low back pain responding to extension exercises and is currently working on developing a
prediction rule for responders to flexion exercises.