The importance of developing evidence-based clinical examinations for low back pain

Pub Date : 2018-12-01 DOI:10.1142/S1013702518010023
A. Wong
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Abstract

Low back pain (LBP) is the number one cause of years lived with disability in the world. Approximately 80% of people experience LBP at least once in their lifetime and many of them remain to have LBP at older ages. Despite the high prevalence of LBP, approximately 90% of LBP are labelled as non-speci ̄c LBP because no clear etiologies can be found. Given that medical imaging has limited values in diagnosing patients with LBP, lumbar imaging is recommended only when serious pathologies (e.g., malignancy, fracture, infection) are suspected. In order to prescribe treatments for patients with LBP, physical therapists need to rely on patient history and clinical examinations to inform clinical decisions. In the absence of robust evidence or knowledge on the assessment criteria for identifying patients with di®erent underlying causes of non-speci ̄c LBP, a Delphi process is commonly used to solicit expert opinions regarding the most appropriate assessment criteria for classifying patients into di®erent subgroups for treatment allocations. Following the Delphi process, further studies should be conducted to evaluate the clinimetric properties of the recommended assessment criteria. Since some clinical examinations initially thought to be useful for di®erentiating di®erent patient subgroups for treatment allocations may display suboptimal clinical values in some patient populations later, any clinical examinations derived from the Delphi process must be evaluated thoroughly before applying them in clinical practice. In this issue of Hong Kong Physiotherapy Journal, Vongsirinavarat and co-workers conducted a single-group, repeated measures reliability study to evaluate the agreement of two experienced physical therapists in using nine assessment criteria derived from a Delphi study to diagnose patients with lumbar facet joint pain in a clinical setting. Speci ̄cally, the assessment criteria include three subjective assessments (i.e., localized unilateral pain, referred pain above knee, and no radicular pain), three movement tests (i.e., pain reduction in °exion, pain in extension, and pain in extension with side °exion and rotation
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发展以证据为基础的腰痛临床检查的重要性
腰痛(LBP)是世界上导致残疾的第一大原因。大约80%的人一生中至少经历过一次腰痛,其中许多人在老年时仍然患有腰痛。尽管腰痛的发病率很高,但由于找不到明确的病因,大约90%的腰痛被标记为非特异性腰痛。鉴于医学影像学对腰痛患者的诊断价值有限,建议仅在怀疑严重病变(如恶性肿瘤、骨折、感染)时进行腰椎影像学检查。为了给LBP患者开处方,物理治疗师需要依靠患者病史和临床检查来为临床决策提供信息。在缺乏强有力的证据或知识的评估标准,以确定非特异性腰痛的不同潜在原因的患者,德尔福过程通常用于征求专家意见,关于最合适的评估标准,将患者分为不同的亚组进行治疗分配。在德尔菲过程之后,应该进行进一步的研究来评估推荐的评估标准的临床特性。由于一些最初被认为对区分不同患者亚组进行治疗分配有用的临床检查可能在某些患者群体中显示出不理想的临床价值,因此在将德尔菲过程衍生的任何临床检查应用于临床实践之前必须进行彻底评估。在这一期的香港物理治疗杂志上,Vongsirinavarat和他的同事进行了一项单组、重复测量的可靠性研究,以评估两位经验丰富的物理治疗师在临床上使用来自德尔菲研究的九项评估标准诊断腰椎小关节痛患者时的一致性。具体来说,评估标准包括三个主观评估(即局部单侧疼痛、膝关节以上的牵涉性疼痛和无神经根性疼痛),三个运动测试(即°外展疼痛减轻、延伸疼痛和侧°外展和旋转的延伸疼痛)
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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