NOAMT conference - bewegen in de MT location:Amsterdam date:26-27 november 2010
Classification of LBP disorders into homogeneous subgroups is considered one of the greatest challenges to enable the application of specific interventions effective in the management and prevention of recurrences of LBP. This invited talk presents an approach to classification, for a subgroup of patients with non-specific chronic LBP and clinical signs of motor control impairment (MCI), proposed by O’Sullivan. This novel classification system acknowledges the complex and multi-dimensional nature of these disorders. A biomechanical approach, linked to known pain provoking postures and movements, to quantify parameters of motor control is suggested. The presentation will discuss a series of studies investigating specific aspects of validity of the proposed mechanism-based classification system. To evaluate the integration of sub-classification strategies in randomized controlled trials (RCTs) for CLBP a systematic review of the literature was conducted.
Clinical sub-groups of NS-CLBP patients with MCI can be discriminated from asymptomatic controls, and each other, using selected parameters of motor control. The data supports the concept of NS-CLBP patients presenting with maladaptive motor control. The differences in trunk muscle activation and lumbo-sacral kinematics in sub-groups of NS-CLBP found in these studies strengthens the hypothesis that there exist distinctly different underlying mechanisms of pain. The findings from these clinical studies lead to a better understanding of the mechanisms behind the LBP disorder. Improved understanding of the mechanisms is likely to lead to more targeted interventions, and subsequently enhance treatment efficacy.
While evidence from recent research supports the need to sub-classify NS-CLBP patients a systematic review highlights the lack of sub-classification strategies is lacking in the majority of all into outcome research (RCTs) on CLBP patients leaving a vacuum for specific management.