Diagnostic Classification of Patients with Low Back Pain: Report on a Survey of Physical Therapy Experts

Abstract

Background and Purpose. A survey of expert orthopedic physical therapists was conducted to assist in the development of a classification system for patients with low back pain (LBP). The goal of the survey was to measure levels of agreement on labels and accompanying constellations of signs and symptoms for subgroups of patients with LBP. Subjects. Twenty-four of the 30 expert orthopedic physical therapists who were originally contacted responded to the survey request. Methods. A modified Delphi technique was used. The first stage involved a review of the literature and identification of 25 diagnostic classes of LBP. Experts were asked to rate the “appropriateness” of each diagnostic class for inclusion in a classification scheme. Clinical findings relevant to each diagnostic class were identified and rated on the degree of “essentialness” to that class. Results. Three diagnostic classes—hypomobility dysfunction, nerve root adhesion, and sacroiliac hypermobility—were distinct in that the agreement criteria for the appropriateness of diagnostic classes as well as the surveyed essential signs and symptoms were met. Six of the 25 diagnostic classes did not meet the minimum levels required for agreement as appropriate diagnostic classes: facet syndrome, chronic pain behavior, muscle strain, iliolumbar ligament sprain, posterior ligament sprain, and myofascial dysfunction. Conclusion and Discussion. The importance of developing homogeneous subgroups of patients with LBP based on constellations of reliable clinical findings is emphasized.