Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185 (3B3), 9000 Ghent, Belgium.
Department of Family Medicine and Primary Health Care, Ghent University, De Pintelaan 185 (6K3), 9000 Ghent, Belgium.
Musculoskelet Sci Pract. 2018 Apr;34:66-76. doi: 10.1016/j.msksp.2018.01.002. Epub 2018 Jan 8.
Nonspecific low back pain (NSLBP) is a common problem. Attempts have been made to classify NSLBP patients into homogenous subgroups. Classification systems based on identifying the underlying mechanism(s) driving the disorder are clinically useful to guide specific interventions.
To establish consensus among experts regarding clinical criteria suggestive of a dominance of 'articular', 'myofascial', 'neural', 'central', and 'sensorimotor control' dysfunction patterns (DPs) in NSLBP patients.
A 2-phase sequential design of a focus group and Delphi-study.
A focus group with 10 academic experts was organized to elaborate on the different DPs discernible in LBP patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 DPs resulting from the focus group.
Fifteen musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating LBP patients completed the Delphi-survey. Respectively, 34 (response rate, 100.0%), 20 (58.8%) and 15 (44.12%) respondents replied to rounds 1, 2 and 3. Twenty-two 'articular', 20 'myofascial', 21 'neural', 18 'central' and 11 'sensorimotor control' criteria reached a predefined ≥80% consensus level. For example, after round 2, 85.0% of the Delphi-experts agreed to identify 'referred pain below the knee' as a subjective examination criterion suggestive for a predominant 'neural DP'.
These indicators suggestive of a clinical dominance of the proposed DPs could help clinicians to assess and diagnose NSLBP patients. Future reliability and validity testing is needed to determine how these criteria may help to improve physical therapy outcome for NSLBP patients.
非特异性下腰痛（NSLBP）是一种常见问题。人们试图将 NSLBP 患者分为同质亚组。基于识别驱动疾病的潜在机制的分类系统对指导特定干预措施具有临床意义。
在 NSLBP 患者中，确定“关节”、“肌筋膜”、“神经”、“中枢”和“感觉运动控制”功能障碍模式（DP）占主导地位的临床标准方面，达成专家共识。
焦点小组和 Delphi 研究的 2 阶段序贯设计。
组织了一个由 10 名学术专家组成的焦点小组，以详细说明可在 LBP 患者中辨别出的不同 DP。随后，设计了一个 3 轮在线 Delphi 调查，以获得焦点小组产生的 5 个 DP 的共识症状和体格检查结果。
来自比利时和荷兰的 15 名擅长评估和治疗 LBP 患者的肌肉骨骼物理治疗师完成了 Delphi 调查。分别有 34（响应率，100.0%）、20（58.8%）和 15（44.12%）名受访者回复了第 1、2 和 3 轮。22 个“关节”、20 个“肌筋膜”、21 个“神经”、18 个“中枢”和 11 个“感觉运动控制”标准达到了预先设定的≥80%共识水平。例如，在第 2 轮后，85.0%的 Delphi 专家同意将“膝以下的牵涉痛”作为提示“神经 DP”主导的主观检查标准。
这些提示所提议的 DP 临床主导地位的指标可以帮助临床医生评估和诊断 NSLBP 患者。需要进一步进行可靠性和有效性测试，以确定这些标准如何帮助改善 NSLBP 患者的物理治疗效果。
