John Childs on the Treatment Based Approach of Low Back Pain

John Childs started his physical therapy career at the Air Force Academy.  He completed his PhD at University of Pittsburgh after his Air Force career. He has worked closely with Anthony Delitto and Julie Fritz. He was later faculty at the Army/Baylor Physical Therapy program. Lately John is doing more health care system based research with the goal of helping patients to enter health care in a more appropriate time or place. John is the CEO of Evidence in Motion which provides residency and fellowship training for physical therapists.

John thinks the most important knowledge a therapist can be armed with in treating low back pain patients is paying attention to the patient and not just the injury or anatomy. He notes he has grown away from treating the pathoanatomical cause with experience. The way that the PT communicates with the patient plays a huge role in recovery and the psychosocial contributors can not be ignored.

John discusses the Treatment Based Classification System. He talks about looking for signs and symptoms that are associated with a benefit from a particular treatment intervention. Integrating these classifications and clinical prediction rules into clinical practice can assist with decision making for acute or subacute patients. The clinical prediction rules help to subgroup patients into one group; patient’s should not be categorized into multiple treatment based groups.   John cautions that there is further research to be done on the clinical prediction rules and that it is still important to later integrate other forms of treatment as the patient progresses.

Some existing Clinical Prediction Rules for the Lumbar Spine are:

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