Abstract
Background Several studies have investigated criteria for classifying patients with low back pain (LBP) into treatment-based subgroups. A comprehensive algorithm was created to translate these criteria into a clinical decision-making guide.
Objective This study investigated the translation of the individual subgroup criteria into a comprehensive algorithm by studying the prevalence of patients meeting the criteria for each treatment subgroup and the reliability of the classification.
Design This was a cross-sectional, observational study.
Methods Two hundred fifty patients with acute or subacute LBP were recruited from the United States and Australia to participate in the study. Trained physical therapists performed standardized assessments on all participants. The researchers used these findings to classify participants into subgroups. Thirty-one participants were reassessed to determine interrater reliability of the algorithm decision.
Results Based on individual subgroup criteria, 25.2% (95% confidence interval [CI]=19.8%–30.6%) of the participants did not meet the criteria for any subgroup, 49.6% (95% CI=43.4%–55.8%) of the participants met the criteria for only one subgroup, and 25.2% (95% CI=19.8%–30.6%) of the participants met the criteria for more than one subgroup. The most common combination of subgroups was manipulation + specific exercise (68.4% of the participants who met the criteria for 2 subgroups). Reliability of the algorithm decision was moderate (kappa=0.52, 95% CI=0.27–0.77, percentage of agreement=67%).
Limitations Due to a relatively small patient sample, reliability estimates are somewhat imprecise.
Conclusions These findings provide important clinical data to guide future research and revisions to the algorithm. The finding that 25% of the participants met the criteria for more than one subgroup has important implications for the sequencing of treatments in the algorithm. Likewise, the finding that 25% of the participants did not meet the criteria for any subgroup provides important information regarding potential revisions to the algorithm's bottom table (which guides unclear classifications). Reliability of the algorithm is sufficient for clinical use.
Footnotes
Ms Stanton, Dr Fritz, Dr Hancock, Associate Professor Latimer, Professor Maher, and Dr Parent provided concept/idea/research design. All authors provided writing and consultation (including review of the manuscript before submission). Ms Stanton, Dr Fritz, Dr Hancock, and Associate Professor Wand provided data collection and participants. Ms Stanton, Dr Fritz, Dr Hancock, Associate Professor Latimer, and Professor Maher provided data analysis. Ms Stanton, Dr Fritz, Dr Hancock, Associate Professor Latimer, Professor Maher, and Associate Professor Wand provided project management and fund procurement. Dr Fritz, Dr Hancock, Associate Professor Latimer, and Professor Maher provided facilities/equipment. Dr Fritz, Dr Hancock, Associate Professor Wand, and Dr Parent provided institutional liaisons.
The study received ethical approval from the Human Research Ethics Committee of The University of Sydney, from the Human Research Ethics Committee of the University of Notre Dame Australia, and from the Sydney South West Area Health Service Ethics Board. The study qualified for exempt status from the Institutional Review Board of Intermountain Healthcare.
This project was supported by the Physiotherapy Research Foundation tagged Physiotherapists' Registration Board of Western Australia research grant. The authors also acknowledge The University of Sydney International Research Scholarship for Ms Stanton's PhD funding, Australia's National Health and Medical Research Council for funding of Professor Maher's research fellowship, and the Australian Research Council for funding of Associate Professor Latimer's Future Fellowship.
- Received August 18, 2010.
- Accepted December 3, 2010.
