Treatment-based classification for low back pain: systematic review with meta-analysis

Area of Science:

• Evidence-based practice in physical therapy
• Clinical classification systems for musculoskeletal disorders

Background:

• Low back pain (LBP) is a prevalent condition with diverse underlying causes.
• Current management strategies for LBP vary, necessitating effective classification systems.
• Treatment-based classification (TBC) aims to guide therapeutic interventions based on patient subgroups.

Purpose of the Study:

• To systematically review the efficacy of TBC in managing acute, subacute, and chronic low back pain.
• To evaluate the impact of TBC across various patient presentations, including specific and nonspecific LBP.

Main Methods:

• A comprehensive literature search was conducted across multiple databases up to December 2021.
• Risk of bias, reporting quality, and certainty of evidence were assessed using the PEDro scale, TIDieR checklist, and GRADE approach.
• Meta-analysis was performed for two specific comparisons due to heterogeneity.

Main Results:

• Twenty-three trials involving 2,649 participants were included, yielding 22 comparisons.
• Most trials exhibited a low risk of bias, but the overall certainty of evidence was low.
• The TBC approach showed potential benefits for acute LBP, sciatica, and spinal stenosis.

Conclusions:

• The TBC approach demonstrates utility in specific LBP patient groups, including acute LBP, sciatica, and spinal stenosis.
• The low certainty of evidence underscores the necessity for more robust, high-quality clinical trials.
• Further research is recommended to solidify the evidence base for TBC in LBP management.