School of Health and Rehabilitation Sciences, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, QLD 4072, Australia.
BMC Musculoskelet Disord. 2012 Feb 20;13:24. doi: 10.1186/1471-2474-13-24.
Several classification schemes, each with its own philosophy and categorizing method, subgroup low back pain (LBP) patients with the intent to guide treatment. Physiotherapy derived schemes usually have a movement impairment focus, but the extent to which other biological, psychological, and social factors of pain are encompassed requires exploration. Furthermore, within the prevailing 'biological' domain, the overlap of subgrouping strategies within the orthopaedic examination remains unexplored. The aim of this study was "to review and clarify through developer/expert survey, the theoretical basis and content of physical movement classification schemes, determine their relative reliability and similarities/differences, and to consider the extent of incorporation of the bio-psycho-social framework within the schemes".
A database search for relevant articles related to LBP and subgrouping or classification was conducted. Five dominant movement-based schemes were identified: Mechanical Diagnosis and Treatment (MDT), Treatment Based Classification (TBC), Pathoanatomic Based Classification (PBC), Movement System Impairment Classification (MSI), and O'Sullivan Classification System (OCS) schemes. Data were extracted and a survey sent to the classification scheme developers/experts to clarify operational criteria, reliability, decision-making, and converging/diverging elements between schemes. Survey results were integrated into the review and approval obtained for accuracy.
Considerable diversity exists between schemes in how movement informs subgrouping and in the consideration of broader neurosensory, cognitive, emotional, and behavioural dimensions of LBP. Despite differences in assessment philosophy, a common element lies in their objective to identify a movement pattern related to a pain reduction strategy. Two dominant movement paradigms emerge: (i) loading strategies (MDT, TBC, PBC) aimed at eliciting a phenomenon of centralisation of symptoms; and (ii) modified movement strategies (MSI, OCS) targeted towards documenting the movement impairments associated with the pain state.
Schemes vary on: the extent to which loading strategies are pursued; the assessment of movement dysfunction; and advocated treatment approaches. A biomechanical assessment predominates in the majority of schemes (MDT, PBC, MSI), certain psychosocial aspects (fear-avoidance) are considered in the TBC scheme, certain neurophysiologic (central versus peripherally mediated pain states) and psychosocial (cognitive and behavioural) aspects are considered in the OCS scheme.
有几种分类方案，每种方案都有自己的理念和分类方法，旨在指导治疗，将腰痛（LBP）患者分为不同亚组。物理治疗衍生的方案通常侧重于运动障碍，但需要探讨其他生物、心理和社会疼痛因素的涵盖程度。此外，在当前的“生物”领域内，骨科检查中的亚组划分策略的重叠尚未得到探索。本研究的目的是“通过开发者/专家调查，审查和澄清物理运动分类方案的理论基础和内容，确定其相对可靠性和相似性/差异性，并考虑方案中生物-心理-社会框架的纳入程度”。
对与 LBP 及亚组或分类相关的文章进行数据库检索。确定了五个主要的基于运动的方案：机械诊断和治疗（MDT）、基于治疗的分类（TBC）、基于病理解剖的分类（PBC）、运动系统障碍分类（MSI）和 O'Sullivan 分类系统（OCS）。提取数据并向分类方案开发者/专家发送调查，以澄清操作标准、可靠性、决策制定以及方案之间的趋同/发散要素。调查结果被整合到审查中，并获得准确性的认可。
方案之间在运动如何提供亚组信息以及更广泛的神经感觉、认知、情绪和行为维度的腰痛方面存在很大差异。尽管评估理念存在差异，但一个共同的要素在于它们旨在确定与疼痛缓解策略相关的运动模式。出现两种主要的运动范式：（i）加载策略（MDT、TBC、PBC）旨在引起症状的集中现象；（ii）改良运动策略（MSI、OCS）旨在记录与疼痛状态相关的运动障碍。
方案在以下方面存在差异：追求加载策略的程度、运动功能障碍的评估以及倡导的治疗方法。大多数方案（MDT、PBC、MSI）以生物力学评估为主，TBC 方案考虑了某些心理社会方面（恐惧回避），OCS 方案考虑了某些神经生理（中枢与外周介导的疼痛状态）和心理社会（认知和行为）方面。
