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Directional Preference and Functional Outcomes Among Subjects Classified at High Psychosocial Risk Using STarT

By |May 14, 2018|McKenzie|

Directional Preference and Functional Outcomes Among Subjects Classified at High Psychosocial Risk Using STarT

The Chiro.Org Blog


SOURCE:   Physiother Res Int. 2018 (Mar 14) [Epub]

Mark W. Werneke, Susan Edmond, Michelle Young, David Grigsby, Brian McClenahan, Troy McGill

Doctoral Programs in Physical Therapy,
Rutgers, The State University of New Jersey,
Newark, NJ, USA


BACKGROUND AND PURPOSE:   Physiotherapy has an important role in managing patients with non-specific low back pain who experience elevated psychosocial distress or risk for chronic disability. In terms of evidence-based physiotherapy practice, cognitive-behavioural approaches for patients at high psychosocial risk are the recommended management to improve patient treatment outcomes. Evidence also suggests that directional preference (DP) is an important treatment effect modifier for prescribing specific exercises for patients to improve outcomes. Little is known about the influence of treatment techniques based on DP on outcomes for patients classified as high psychosocial risk using the Subgroups for Targeted Treatment (STarT Back Screening Tool). This study aimed to examine the association between functional status (FS) at rehabilitation discharge for patients experiencing low back pain classified at high STarT psychosocial risk and whose symptoms showed a DP versus No-DP.

METHODS:   High STarT risk patients (n = 138) completed intake surveys, that is, the lumbar FS of Focus On Therapeutic Outcomes, Inc., and STarT, and were evaluated for DP by physiotherapists credentialed in McKenzie methods. The FS measure of Focus On Therapeutic Outcomes, Inc., was repeated at discharge. DP and No-DP prevalence rates were calculated. Associations between first-visit DP and No-DP and change in FS were assessed using univariate and multivariate regression models controlling for 11 risk-adjusted variables.

RESULTS:   One hundred nine patients classified as high STarT risk had complete intake and discharge FS and DP data. Prevalence rate for DP was 65.1%. A significant and clinically important difference (7.98 FS points; p = .03) in change in function at discharge between DP and No-DP was observed after controlling for all confounding variables in the final model.

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Conservative Management of a 31 Year Old Male With Left Sided Low Back and Leg Pain: A Case Report

By |November 11, 2012|Chiropractic Care, McKenzie, Rehabilitation, Spinal Manipulation|

Conservative Management of a 31 Year Old Male With Left Sided Low Back and Leg Pain: A Case Report

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2012 (Sep);   56 (3):   225-232

Emily R. Howell, BPHE(Hons), DC, FCCPOR(C)

Ashbridge’s Health Centre,
1522 Queen St. East,
Toronto, ON M4L 1E3.
dremilyhowell@hotmail.com


OBJECTIVE:   This case study reported the conservative management of a patient presenting with left sided low back and leg pain diagnosed as a left sided L5-S1 disc prolapse/herniation.

CLINICAL FEATURES:   A 31-year-old male recreational worker presented with left sided low back and leg pain for the previous 3-4 months that was exacerbated by prolonged sitting.

INTERVENTION AND OUTCOME:   The plan of management included interferential current, soft tissue trigger point and myofascial therapy, lateral recumbent manual low velocity, low amplitude traction mobilizations and pelvic blocking as necessary. Home care included heat, icing, neural mobilizations, repeated extension exercises, stretching, core muscle strengthening, as well as the avoidance of prolonged sitting and using a low back support in his work chair. The patient responded well after the first visit and his leg and back pain were almost completely resolved by the third visit.

SUMMARY:   Conservative chiropractic care appears to reduce pain and improve mobility in this case of a L5-S1 disc herniation. Active rehabilitative treatment strategies are recommended before surgical referral.

Recent Studies Have Also Shown That:

Back Surgery Fails 74% of the Time


From the FULL TEXT Article

Introduction:

Low back pain has been reported as the chief complaint for 23.6% of patients presenting to chiropractic offices. [1]   Disc herniations that lead to nerve-root compromise account for less than 15% of chronic low back pain cases. [2]   Over 95% of lumbar disc herniations occur at L4–5 or L5-S1 levels, and only 2% of herniations require surgery, 4% have compression fractures, 0.7% have spinal malignant neoplasms, 0.3% have ankylosing spondylitis and 0.1% have spinal infections. [2, 3]

Leg pain is estimated to be found in 25–57% of all low back pain cases and accounts for large costs, disability, chronicity and severity. [4, 5, 6] Many conservative treatments have been shown to be effective in the management of this condition and are favorable to pursue before considering any surgical interventions, such as: modalities, soft tissue therapy, spinal manipulations or mobilizations, pelvic blocking, McKenzie/end-range loading exercises, lumbar stabilization exercises and neural mobilizations, patient education, reassurance, short-term use of acetaminophen, and nonsteroidal antiinflammatory drugs. [2, 3, 7–24] The purpose of this case report is to describe the successful management of a patient with low back and leg pain.


Discussion:

There are more articles like this @ our:

Low Back Pain and Chiropractic Page and the:

Chiropractic and Sciatica Page

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