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OUTCOMES BASED ON A LOW BACK PAIN CLASSIFICATION SYSTEM

Greg McIntosh, Hamilton Hall, Christina Boyle Canadian Back Institute (CBIHealth), Research, Oakville, Canada Introduction. One goal of LBP assessment is to direct clinicians to specific sub-groups that benefit from particular treatment approaches. The term non-specific LBP does not direct treatment or instil confidence in patients. The purpose of this study was to compare outcomes in a conservative care setting between patients assessed and treated based on a diagnostic system of LBP classification and patients managed without a classification system. Methods. This was a prospective double-cohort study of mechanical LBP cases (n 2223) who started a rehabilitation program at 11 clinics across Canada between February 06 and August 07. A group of patients attending 7 clinics specifically trained in the use of a LBP classification system using patterns of pain, not anatomic site or pathological process (n 1356) were compared with patients from 8 clinics using a generic, non-classification approach (n 754). Patients are categorized into one of five classifications, each dictating a separate treatment approach. The inter-tester reliability of the classification system has been previously documented (agreement 79%, kappa 0.61). Results. The mean age of the cohort was 44.9 years (SD 13.5, range 18–92) with 54.6% males. The mean lagtime from injury to treatment was 114.4 days (median 37 days). Treatment based on this classification system resulted in more pain reduction (p 0.001), higher functional improvement (p 0.001), less medication use (p 0.001) and fewer treatment days (p 0.001), compared to a generic approach. The five patterns of pain showed statistically significant differences in outcomes. Discussion. Outcome differences between the five classified groups suggest that LBP is heterogeneous, and recognizable by clinical patterns of patient characteristics. The results support the effectiveness of a classification system that matches treatment to patient presentation and pattern of pain. Conclusion. Classification-based treatment had a positive impact on outcomes. I N T E R N A T I O N A L S O C I E T Y F O R T H E S T U D Y O F L U M B A R S P I N E