The Back Pain Controversy Between Physical Therapists

Maybe I'm embellishing just a little bit.  I honestly don't think back pain is that much of a controversy between all physical therapists.  In my opinion, there is a subgroup of physical therapists who are definitely opinionated about current research revolving around subgrouping patients into a treatment-based classification system.

In my opinion, the controversy started when "Annals of Internal Medicine" published a validation study of a clinical prediction rule that would help identify patients with back pain who would respond to manipulation.  From across the pond, a few Australians are in disagreement in the logistics of how subgroups are determined.  Then of course, there were a couple of podcasts created where Mark Hancock, PT, Rob Herbert, PT and Julie Fritz, PT discussed the clinical prediction rule and subgrouping patients.  Most recently, a slew of colleagues had additional work published focusing on the clinical prediction rule and comparing 3 manual techniques (2 thrust manipulation techniques and a non-thrust technique).

As I was checking out the programming for the American Physical Therapy Association Combined Sections Meeting, I saw a session titled, "Diagnosis and Prognosis of Low Back Pain - Are Current Guidelines Too Simple?"  on February 18 from 2:30-4:30.  Guess the presenters?  Mark Hancock, PT and Christopher Maher, PT.  Wowwiee, huh?

I have no idea if the controversy in opinions will be addressed during the session.  I do know from reading Blink the more complicated we humans make decision-making, the more prone to error we are (or we get sidetracked and boggged down with useless information).  This is proven true through the work of Lee Goldman's crunching of data and creating an algorithm to predict a heart attack.  No randomized controlled studies were used by Goldman - just data.  Goldman designed a decision tree for treating a patient with chest pain.  A patient with chest pain needed the results of an ECG combined with 3 things:  1) Is the pain unstable angina? 2) Is there fluid in the lungs? 3)  Is the systolic blood pressure below 100?  Brendan Reilly at Cook County Hospital implemented the decision tree.  Doctors guessed right 75-89% of the time; the algorithm guessed right 95% of the time.  A beautiful example of less is more.

There could be some good dialogue occurring between attendees and presenters.  At the bare minimum, for those of you wanting to compare an authentic Australian accent with your GPS Australian voice setting, the opportunity has presented itself.

photo by funkypancake via Flickr

~Selena