Physical Therapists Attempt to Classify Low Back Pain
It's best to treat the cause of any problem, not just the symptoms. With low back pain (LBP) the cause is often not clear. There's a new system used by physical therapists (PTs) to help with this problem. It's called the Treatment-Based Classification (TBC) system. It's used to put LBP patients into one of seven groups. The groups are divided up by the treatment used to relieve the patient's signs and symptoms.

Any system must be easy to use. It must apply to most of the patients. In this study the reliability of four therapists newly trained in the TBC system was measured. Can they use the system after a short training period? How much practice with the system is needed? Does each therapist classify each patient in the same way? This is called interrater reliability. High interrater reliability is the goal of any classification system.

Four experienced PTs but new to the TBC system rated 48 patients. Each PT read an article about the TBC system and took a one-day training course before seeing the patients. None of the therapists knew how the other therapists rated each patient.

The PTs in this study were unable to agree on patient classification using the TBC system. One therapist disagreed with the other three in all but two cases. The remaining three PTs agreed with each other about half the time. This is considered "moderate" interrater reliability.

The authors of this study think a one-day training course in the use of the TBC system probably isn't enough for all PTs. More information and a better understanding of the TBC system may be needed before all PTs make the same decisions using it.

Other factors to explain the lack of agreement may include the inability to learn a new way of viewing patients. Or perhaps there's an unwillingness to follow different rules in making decisions about patients. More study is needed before the TBC is adopted for use by all PTs.
Deborah Givens Heiss, PT, PhD, OCS, et al. The Interrater Reliability Among Physical Therapists Newly Trained in a Classification System for Acute Low Back Pain. In Journal of Orthopaedic & Sports Physical Therapy. August 2004. Vol. 34. No. 8. Pp. 430-439.