Proposal for Patrick Kitzman to the KY Physical Therapy Association

Rationale Low back pain (LBP) is the second most common neurological ailment in the United States (1). The effects of LBP can lead to physical disability, which is a major cause of time off work every year. Consequently LBP is costly and a common occurrence in primary care where many people suffering an acute episode do not recover completely and a significant number of this population commonly progress to chronic or recurrent LBP (2). Therefore, early management of LBP is important to be effective (2). Effective LBP management in the past has included a variety of treatments with limited outcomes due to physical therapists' trying to treat LBP as a homogeneous condition (2). Evidence-based practice guidelines have been developed but there has been little evidence to demonstratethe change in physical therapists' clinical practice to implement these guidelines. Classification of patients, determined by signs and symptoms, is the goal of the diagnosis process (3). According to the Guide to Physical Therapy Practice and through evidence-based practice, the most efficient strategies of management occur by using effective subgrouping methods to direct decision making (4,6,7). Delitto, Erhard and Bowling (5) proposed a treatment-based classification system for subgrouping acute / nonspecific low back pain. This system uses patient self pain report, disability (measured by the modified Oswestry questionnaire) and clinical findings to group patients into four treatmer categories; mobilization, traction, immobilization and specific exercise (5). Since this classification has been developed and utilized over the subsequent years, there has now been some evidence to support using subgrouping methods with acute nonspecific low back pain to guide treatment interventions to improve patient outcomes (4). Classification systems are available to guide decision-making in LBP and have been the focus of some research studies in recent years due to the increased knowledge with associated signs and symptoms of low back pain (4). Further evidence supports the proposal that if initial clinical low back pain signs and symptoms are treatment matched, clinical outcomes can be improved (4). Brennan et al., (2) found matching interventions initially to the evaluation of low back pain signs and symptoms reduced disability. This is important in the population of acute low back pain sufferers as many of them develop long term disability if they do not quickly recover (8). Therefore, initial decision making on subgrouping LBP to guide treatments could have long term consequences.