Treatment-Based Classification System for LBP

cards 38-48 are extra practice cards

What should you do when dealing with patients with LBP

Classify patients into subgroups with specific, targeted interventions.

Which four existing classification systems are mentioned as influences on the Treatment Based Classification (TBC)?

McKenzie (MDT)
Sahrmann (MSIS)
Hamilton Hall (HH)
Delitto et al (TBC).

What is a significant limitation of the TBC regarding patient presentation over time?

Psychosocial factors and their influence on LBP are not well understood
Patients can move from one classification category to another during an episode of care and/or may fit in 2 categories at any given point
We may not be able to name a specific pathoanatomical diagnosis

In the current TBC model, who performs the first level of triage?

The First-Contact Health Care Provider

What are the three management approaches determined by the First-Contact Provider in the TBC triage?

Medical Management
Rehabilitation Management
Self-Care Management.

Which clinical findings indicate a need for Medical Management in the first triage level?

Red flags
Medical comorbidities precluding rehab
Leg pain with progressive neurologic deficits

Which clinical findings suggest Rehabilitation Management during the first triage level?

Medium-to-high psychosocial risk
Low psychosocial risk with predominantly leg pain
Minor or controlled medical comorbidities

Under what clinical conditions is Self-Care Management recommended by the first-contact provider?

Low psychosocial risk
Predominantly axial LBP
Minor or controlled comorbidities

List examples of "red flags" in the current TBC model.

Drop foot
Bowel or bladder dysfunction
Unexplained weight loss
Fever
Loss of balance

List examples of "yellow flags" mentioned in the TBC current model.

History of cancer
Night pain
Previous infection
Immunosuppressive disorders
Bilateral LE weakness/numbness
Psychosocial concerns

Once a patient is triaged to the Rehabilitation Provider, what are the three potential rehabilitation approaches?

Symptom Modulation
Movement Control
Functional Optimization

What are the typical clinical findings for a patient in the Symptom Modulation category?

High disability
Volatile symptom status
High to moderate pain

Which four treatment strategies are primary for the Symptom Modulation category?

Directional preference exercises
Manipulation/mobilization
Traction
Active rest

What are the typical clinical findings for a patient in the Movement Control category?

Moderate disability
Stable symptom status
Moderate to low pain

Which three treatment types are recommended for patients in the Movement Control category?

Sensorimotor exercises
Stabilization exercises
Flexibility exercises

What are the typical clinical findings for a patient in the Functional Optimization category?

Low disability
Controlled symptom status
Low to absent pain

Which four treatment strategies are used for Functional Optimization?

Strength and conditioning
Work- or sport-specific tasks
Aerobic exercises
General fitness

Stage 1 (Symptom Modulation) of the current TBC model integrates which classification system?

Mechanical Diagnosis and Therapy Classification (McKenzie)

During stage 1 (symptom modulation) what is typically focused on

Extension
Flexion
Lateral shift
Immobilization
Traction
Mobilization

List the four key exam components for the Symptom Modulation stage.

Oswestry Disability Index
Neural Examination
Repeated Movements Assessment
Tests for Hypomobility

Stage 2 (Movement Impairment) of the TBC model integrates which existing model?

Movement System Impairment Syndromes Model (Sahrmann)

During stage 2 (movement impairment) what is typically focused on

Flexibility Deficits/Joint Mobility
Strength deficits
Cardiovascular deficits
Coordination deficits
Body mechanics/Posture

List four key exam components for the Movement Impairment stage.

Muscle Length Tests
Motor Control/Functional Exam
Tests for Endurance
Cluster of Signs for Instability

Which two specific intolerances are classified under Stage $3$ (Functional Classification)?

Activity Intolerance and Work Intolerance.

What specific interventions are used to address "Neural Restrictions"?

Neural tensioners and sliders

What interventions are primarily used for "Joint Restrictions"?

Manipulations and various mobilizations

What interventions are used to address "Soft Tissue Restrictions"?

Soft tissue techniques, dry needling, and stretching.

When considering movement control: activation, motor control is of (MORE,EQUAL,LESS) focus than Endurance/Strength

More

When considering movement control: activation, what is the recommended treatment

Training to activate hypoactive muscles or isolate movement patterns

When considering movement control: acquisition, motor control is of (MORE,EQUAL,LESS) focus than Endurance/Strength

Equal

When considering movement control: acquisition, what is the recommended treatment

Training to acquire the skill of dissociating or coordinating movements of the lumbar spine and adjacent regions

When considering movement control: assimilation, motor control is of (MORE,EQUAL,LESS) focus than Endurance/Strength

Less

When considering movement control: assimilation, what is the recommended treatment

Training to assimilate loaded multiplanar movements into ADLs

A patient with leg pain, paresthesia, a 7/10 pain rating, and a 52% Oswestry score belongs in which rehabilitation category?

Symptom Modulation

If a patient's calf paresthesia disappears temporarily during lumbar extension movements, which exercise type is supported?

Extension-based exercises

After localizing LBP to 3-4/10 with ROM limits, what assessment should be performed next if joint issues are suspected?

Joint play and position

If a patient reaches 1/10 pain and exhibits no hypomobility or flexibility deficits, what is the next appropriate exam focus?

Motor control and strength

A patient with "low psychosocial risk status" and "predominantly axial low back pain" is suited for _____ management.

Self-Care

According to the current model, high disability combined with a volatile symptom status points toward which rehabilitation approach?

Symptom Modulation

Which stage of the TBC rehabilitation model focuses on sensorimotor and stabilization exercises?

Movement Control (Stage 2)

What kind of exercises act as a "Bridge" between mobility and functional optimization?

Range of motion exercises

Which triage category in the first contact level involves patients with "Red flags"?

Medical Management

Within the Movement Control framework, which three factors are considered together to guide intervention?

Joint Mobility, Stability, and Yellow Flags.

What is the primary treatment integrated from the McKenzie system into the Symptom Modulation stage?

Directional preference exercises

A patient with "moderate disability," "stable symptom status," and "moderate to low pain" is classified under _____.

Movement Control

Which level of first-contact triage handles patients with "Medium-to-high psychosocial risk status"?

Rehabilitation Management

If a patient is classified in the "Symptom Modulation" group, what is their expected level of pain intensity?

High to moderate

What is the primary goal of the "Acquisition" phase in the Movement Control cycle?

Addressing Joint and Soft Tissue restrictions to move toward functional tasks.