In regards to Dr. Fritz’s et al article shown at the bottom, I wanted to see if I was able to generalize their population to my own patient population.1 I did not compare statistical differences between populations, but from initial glance this article was an outpatient orthopedic setting with a mean age of 44, similar to our setting. Next, I want to know that the TBC will be used properly by the therapists in our clinic. The kappa statistic = 95% with a small confidence interval (.87-1.0) making it a very reliable method.1 Lastly, I want to know that utilization of treatment based classifications were useful to patients. This article showed that utilization of TBC had greater improvements in NDI when compared to non matched patients. This data is strong enough to show its place in a clinic. Not every therapist utilizes this approach, but most consider it. For our clinic purposes, I am going to review the different classifications and the CPR for inclusion criteria into each.
Classification Examination Findings Interventions1
Mobility
- Recent onset of symptoms (<30 days)
- Younger age (<60 years old)
- No signs of nerve root compression or symptoms distal to the elbow
Matched treatment: Manipulation/mobilization of the cervical or thoracic spine, neck muscle strengthening
Centralization
- Signs of nerve root compression or symptoms distal to the elbow
- Peripheralization/centralization of symptoms with neck movements
- Diagnosis of radiculopathy
Matched treatment: Mechanical or manual traction, repeated movement (eg, retraction) to centralize symptoms
Exercise and Conditioning
- Longer duration of symptoms (>30 days)
- No signs of nerve root compression Lower pain and disability scores
Matched Treatment: Neck muscle strengthening, upper extremity strengthening exercises
Pain Control
- Recent, traumatic onset (e.g., whiplash)
- High pain and disability scores
- Intolerance for most activities
Matched Treatment: Cervical mobilization, active range of motion, avoid cervical immobilization
Reduce Headache
- Chief complaint of headaches accompanying neck pain
- Headache affected by neck movement
- No history or signs of migraine
Matched Treatment: Manipulation/mobilization of the cervical spine, strengthening of the cervical deep neck flexors, scapular muscle strengthening
Original post: July 20, 2013
1) Fritz, J. M., & Brennan, G. P. Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain. Physical Therapy (2007). 87(5), 1–12.