Classification systems are acknowledged to be useful in clinical practice to guide clinicians in evaluating and treating patients with low back pain. General surveys indicate minimal utilization of two main types of classification systems supported in the literature, which are the treatment based and movement based systems.

The purpose of this study was to survey a group of physical therapists who treat low back pain to determine

1) Which classification systems they use and

2) What are the barriers to classifying LBP and

3) What outcome surveys were most commonly used and

4) What are the barriers to using outcome studies?

This study was a cross sectional cohort design with descriptive qualitative methods. Sample was taken from licensed physical therapists in the state of Kentucky in the year 2009. Of 2673 therapists, 359 were determined to work with patients with low back pain, and 250 were selected to send a survey. 120 therapists responded to the survey, with 116 responding that they did treat patients with low back pain. The survey was designed by the author, with quantitative and qualitative data collected.

Survey results indicated that 86% of respondents do use a classification system. 65% reported using multiple classification systems. 61% reported using the McKenzie approach as their classification system. 58% reported using treatment based classifications, and 21% reported using the Movement based classification approach.

Barriers to utilization of classification systems included

1) no training,

2) classification systems are too limiting, and

3) the systems are not useful.

85% reported using outcome measures. 68% of respondents used the Oswestry Disability Index (ODI). 59% used the numeric pain rating scale. 6% used the Roland Morris Disability Questionnaire. 38% agreed that outcome tools improved with patients with LBP.

Barriers identified to using the outcome tools included

1) lack of time

2) patient difficulty

3) therapist habit

4) lack of knowledge

5) lack of administrative support

6) tools not useful in making clinical decisions.

Conclusions:
Classification systems are being utilized for evaluation of low back pain in the state of Kentucky but the TBC and movement based systems were not predominant. In addition, outcome measures were being used. Comments: The response rate was smaller than expected (48% vs. 70% as expected), indicating the need for further studies. The authors write “the McKenzie approach is ‘user-friendly’ … patients with LBP (that) respond to the direction preference in that system leading to identification of the treatment more quickly. For these reasons a successful outcome may be achieved more quickly”. This study identified a possible disconnect between what the literature reports in regards to classification systems and outcome tools and practice habits. The clinical significance for the MDT clinician: While the vast majority of respondents identified the McKenzie method for classification of low back pain, for many it was not their only classification system. Looking at the identified barriers to application of the classification systems may help to improve effective dedicated utilization.

Lumbar: Surveys of Physical Therapy practice