[Physiotherapy in low back pain--indications and limits].

Area of Science:

• Rehabilitation Medicine
• Physical Therapy
• Health Services Research

Context:

• Current back pain management guidelines lack consistency, particularly regarding physiotherapy.
• National and international guidelines (e.g., German Heilmittelrichtlinien, WHO ICIDH-2) offer varying approaches.
• There's a need for a unified framework for effective, efficient, and appropriate physiotherapy for back pain.

Purpose:

• To critically evaluate the indications and limitations of physical therapy in back pain management.
• To explore the alignment of current physical therapy practices with the WHO's International Classification of Functioning and Disability (ICIDH-2).
• To advocate for a revised framework for physiotherapy that incorporates functional and psychosocial outcomes.

Summary:

• Physical therapy for back pain currently addresses body structure/function, activity, and participation levels, aligning with ICIDH-2.
• Multimodal programs incorporating physical activity, psychological support, and daily living activities are beneficial for chronic low back pain.
• German guidelines (Heilmittelrichtlinien) primarily focus on structural/functional deficits, not aligning with evidence for activity/participation levels, and lack differentiation for acute vs. chronic conditions.

Impact:

• Current guidelines may not reflect the full scope of effective physical therapy for back pain, potentially limiting patient recovery.
• Adopting an ICIDH-2 framework could lead to more individualized and effective physiotherapy interventions.
• Future research should investigate the implications of ICIDH-2 for physical therapy management and outcome assessment in back pain.