Purpose: Low back pain (LBP) is a common condition in adolescents, and a specific pathoanatomical origin for the symptoms cannot always be determined. The purpose of this work was to examine the clinical presentation and outcomes of rehabilitation for adolescents with LBP.
Methods: This study was completed in three phases. Phase 1 was a retrospective review of 25 patients under the age of 18 who were seen for treatment of LBP. Information regarding the patients diagnoses, history, examination, and outcome were collected from chart review. Phase 2 was a review of 99 patients under the age of 18 with LBP. Numerical Pain Rating Scale (NPRS) and the Modified Oswestry Questionnaire (OSW) were recorded. Phase 3 consisted of a prospective study of treatment-based classification (TBC) of 34 adolescent patients seen in physical therapy for LBP. Treatment duration and content were at the clinicians discretion. Patients completed an OSW and NPRS before and after physical therapy. Patients were classified using a TBC algorithm, and effectiveness of classification on outcome was examined.
Results: In study 1, initial pain scores were lower if a specific pathology was present (P=.001). Initial pain and OSW scores were poorly correlated (r= 0.16). 44% (n=11) of patients scored under the floor value of 12% on OSW. A second examination of the OSW in study 2 concluded that OSW was moderately correlated with NPRS (0.59). Chronbachs alpha was 0.86. All 10 items in OSW appeared to load onto two latent factors. In study 3, a classification decision was able to be made with a moderate degree of reliability (0.53 (0.28, 0.79) ≤ κ ≤ 0.89 (.74, 1.0)) in all of the 34 patients. Stabilization was the most commonly prescribed treatment by clinicians. Those who were matched to their TBC classification experienced fewer numbers of visits than those who were not.
Conclusions: It appears the OSW is a valid and reliable tool for assessing clinical outcome of physical therapy intervention for adolescents with LBP. These results also suggest that a TBC approach to treatment of LBP in this population may be effective for improvements in clinical outcome.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-04172009-145854 |
| Date | 05 June 2009 |
| Creators | Clifford, Shannon N |
| Contributors | Tanya Hagen, MD, Julie M. Fritz PhD, PT, ATC, Patrick Sparto PhD, PT, Anthony Delitto PhD, PT, FAPTA |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-04172009-145854/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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