The treatment-based classification system (TBC) for the treatment of patients with low back pain (LBP) has been in use by clinicians since 1995. In this manuscript, the authors updated the TBC by maintaining its strengths, addressing its limitations, and incorporating recent research developments. The current update of the TBC has two levels of triage: the level of the first contact healthcare provider and the level of the rehabilitation provider. At the level of first contact healthcare provider, the purpose of the triage is to determine if the patient is an appropriate candidate for rehabilitation either by ruling out serious pathologies and serious comorbidities, or determining whether the patient is appropriate for self-care management. At the level of the rehabilitation provider, the purpose of the triage is to determine the most appropriate rehabilitation approach given the patient’s clinical presentation. The authors described 3 rehabilitation approaches. A symptom modulation approach is for patients with a recent, new or recurrent, LBP episode that has caused significant symptomatic features. A movement control approach is for patients with moderate pain and disability status. A function optimization approach is for patients with low pain and disability status. The authors emphasized that the psychological and comorbid status should be assessed and addressed in each patient.
Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, neck pain ranked 4th highest in terms of disability and 21st in terms of overall burden.