OCS Study Lumbar Spine
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What are the classification categories used for patients with acute LBP?
- Specific Exercise
What is the minimum clinically important difference on the 0 to 10 NPRS?
Higher or lower scores on the modified Oswestry Disability Questionnaire indicate greater levels of perceived disability?
What is the minimum clinically important difference on the modified Oswestry Disability Questionnaire?
Do higher or lower scores indicate greater levels of fear-avoidance beliefs?
Howmany items on the work subscale of the FABQ?
What is the score range for each item?
- 7 items
- Each item scored 0 to 6
What is the total score range for the FABQ?
0 to 42
What score on the FABQ should raise concerns about prolonged disability and may indicate a need for a multidisciplinary approach?
Greater than 34
What score on the FABQ has been associated with a reduced likelihood of success with a manipulation treatment?
Greater than 18 on the FABQ work
How many items on the FABQ physical activity subscale?
What score on then FABQ physical activity is the cuttoff for cognitive -behavioral treatment?
13 to 14 points
Are patients with signs of nerve root compression generally believed to be appropriate for manipulation classification?
What is the CPR for lumbar manip?
- Less than 16 days
- At least 1 hypomobile segment
- At least 1 hip with greater than 35deg of IR
- No symptoms distal to the knee
- Less than 19 points of the FABQ work
What are the 2 most important factors for predicting suces with spinal manipulation?
- Duration of symptoms
- Lack of symptoms distal to the knee
What is the positive likelihood ratio if at lest 4 of 5 findings with the lumbar CPR are present?
What AROM exercises are reccommended following lumbar manip?
- Perlvic tilst in supine
- Rocking in quadruped
In the supine manip technique should the PT stand on the same side or opposite side to be manipulated?
Which direction should the patient be sidebent?
- Opposite of side to be manipulated
- Side bending toward the side to be manipulated
What findings indicate a need for stabilization training?
- Frequent recurrent episodes of LBP precipitated by minimal perturbations
- Deformity (such as lateral shift) with prior episodes
- Short-term relief form manipulation
- History of trauma
- Use of oral contraceptives
- Improvement of symptoms with a brace
What four variables were identifed as most predictive of success with stabilization training?
- Patient age less than 40
- Positive prone instability test
- Aberrant movements during AROM
- Average SLR passive ROM greater than 90deg
What is the likelihood of success from stabilization exercises with at least 3 of 4 variables present?
67%, up from 33%
What are 3 different aberrant motions?
- Instability catch: a sudden movement that occurs out of the plane of the intended motion.
- Thigh climbing:
- Painful arc:
What component of the physical exam is most important to the specific exercise classification?
Active motion assessment with the response of symptoms to movements.
What patient population should get static traction or longer hold times with intermittent traction?
- Youger patients with intervertebral disk pathology
- Intermittent forces with shorter hold time are used for older patients with degenerative changes, possibly stenosis.
What lumbar traction force has been recommended?
40% to 60%
When is surgery recommended for spondylolytic conditions?
When the slippage exceeds 50% of the vertebral body width (grade III).
What red flags should raise a suspicion of spinal tumors?
- Age greater than 50
- Unexplained weight loss
- No relief with bed rest
- Prior history of cancer
What findings are important in raising suspicion of ankylosing spondylits?
- Age less than 35 when symptoms begin
- Relief with exercise
- The need to get out of bed at night to relieve discomfort
What are red flags for infections conditions of the low back?
- Recent history of an infection such as a UTI
- IV drug use
- Immune suppression from steroids
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