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Outcome of Pregnancy-Related Lumbopelvic Pain Treated According to a Diagnosis-Based Decision Rule

Outcome of Pregnancy-Related Lumbopelvic Pain Treated According to a Diagnosis-Based Decision Rule

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther 2009 (Oct); 32 (8): 616–624

Donald R. Murphy, DC, Eric L. Hurwitz, DC, PhD, Ericka E. McGovern, DC

Rhode Island Spine Center, Pawtucket, RI 02860, USA. rispine@aol.com


OBJECTIVE:   The purpose of this study was to describe the clinical outcomes of patients with pregnancy-related lumbopelvic pain (PRLP) treated according to a diagnosis-based clinical decision rule.

METHODS:   This was a prospective observational cohort of consecutive patients with PRLP. Data on 115 patients were collected at baseline and on 78 patients at the end of the active treatment. Disability was measured using the Bournemouth Disability Questionnaire (BDQ). Pain intensity was measured using the Numerical Rating Scale for pain (NRS). Patients were also asked to self-rate their improvement. Care was provided by a chiropractic physician/physical therapist team.

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Each patient was examined and treated in the manner that would occur in ordinary clinical circumstances at the Rhode Island Spine Center. Care was provided by a chiropractic physician/physical therapist team. Details of this DBCDR approach are provided elsewhere. [8] This decision rule is designed to allow the clinician to formulate a working diagnosis upon which treatment decisions can be made.

It is based on 3 questions of diagnosis: [8]:

  1. Are the symptoms with which the patient is presenting reflective of a visceral disorder, or a serious or potentially life-threatening disease?   This question considers findings such as fever, chills or rigors, previous history of cancer and, particularly in the pregnant patient, bleeding, spotting, unusual discharge, or episodes of diarrhea. The answers to this question are sought via medical history, physical examination and, when indicated, special tests.

  2. From where is the patient’s pain arising?   This question considers signs suggestive of pain arising from disk, joint, nerve, or muscle. The following signs were considered:

    a.   Centralization signs:   these are thought to arise from disk pain and were evaluated via historical factors [13] as well as the end-range loading examination that is part of the McKenzie system. [14]

    b.   Segmental pain provocation signs:   these are thought to arise from joint pain and were evaluated via historical factors [13, 15] as well as pain provocation tests. [13, 16-18]

    c.   Neurodynamic signs:   these are thought to arise as a result of pain from neural structures, particularly the nerve root, and were evaluated via historical factors, nerve root provocation tests, [19, 20] and neurologic examination.

    d.   Myofascial signs:   there are thought to arise from myofascial trigger points and were evaluated via trigger point palpation. [21]


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