The Monday Memo
September 19, 2016 PITT DPT STUDENTS
PPTA September Meeting Highlight
Last Tuesday, the Southwest division (SWD) of the Pennsylvania Physical Therapy Association (PPTA) held their September meeting. At this meeting, they invited Professor Michael Timko to speak. Professor Timko gave a presentation titled “The Treatment Based Classification System for Low Back Pain: 20 Years and Still Moving Forward.” He started off by talking about how the current system of treating back pain called “the Treatment-Based Classification System” (TBC) developed in 1995. This system broke down clinical decision making into three levels. Level 1 involves whether or not a patient should be seeing a physical therapist, or is there some sort of pathology present that requires a referral? Level 2 involves staging the patient’s back pain at either Stage I, II, or III. Level 3 involves the therapist deciding what techniques and interventions should be used to treat a patient depending on their pain stage. This ranking system has been widely accepted in the physical therapy profession for 12 years, and it was recently revised in 2007 to make it more evidence based. The system still has its limitations though.
In 2015, a new system of classifying back pain was created. Led by one of Pitt’s faculty, Dr. Muhammad Alrwaily, he and several other faculty members came up with the new treatment based classification system, which streamlined the levels and stages into an algorithm for the therapist to use during evaluation and treatment. In July 2016, this new system was published in Physical Therapy, Journal of the American Physical Therapy Association. The newest DPT class at Pitt had a full lecture on this system during Boot Camp 1.0 conducted by Professor Chris Bise. Level 1 has been replaced with deciding which management approach the first contact provider should take, because now physical therapists fall under that category with direct access. The three different approaches are red for medical management (should not be seen by a physical therapist because red flags or comorbidities were discovered), yellow for rehabilitation management, and green for self-care management. If a patient falls in the yellow category, then one of three rehab approaches is determined. The determining factors are based on the degree of disability from the injury (high, moderate, or low), symptom status (volatile, stable, or controlled), and pain level (high, moderate, low, or absent). A patient with high disability, volatile symptoms, and high to moderate pain is placed in the “Symptom Modulation” group and treated with directional preference, manipulation/mobilization, traction, and active rest. Patients with moderate disability, stable symptom status, and moderate to low pain are placed in the “Movement Control” group. These patients are treated with sensorimotor exercises, stabilization exercises, and flexibility exercises. The final group, “Functional Optimization,” are for patients with low disability, controlled symptoms, and low to absent pain. When a patient reaches this group, the treatment is strength and conditioning exercises, work or sport specific tasks, aerobic exercise, and general fitness exercises.
Professor Timko emphasized the key to these new groups as compared to the previous system is that patients are able to move from group to group during the course of treatment. Someone might come in to the clinic one day in the movement control group, aggravate the injury over the weekend, and then come back to the clinic in the symptom modulation group. The algorithm they created was developed to ensure a patient never gets stuck in a group and to act as a guide for the therapist in assessing the status of a patient and which treatment strategies are appropriate for resolving the injury.
Professor Timko had one more message underlying his presentation that a lot of our faculty have been emphasizing as well. Physical therapy as a field in medicine is changing dramatically. We are lucky as Pitt students to attend a program that Justin Moore, CEO of the APTA, stated is at “the forefront of reforming the field” from professors who are “very active in where the profession is going.” Physical therapists are gaining more and more recognition as experts in the human movement system within health care in this country. Professor Timko stated that there are jobs for physical therapists that will exist in 5 years that don’t exist today. He doesn’t want us to just graduate, go out into the clinic and only regurgitate treatment styles; he wants us to enter the field and keep pushing it forward. Our faculty are constantly doing just that and they want us to follow suit.
If you would like further information, take a look at “Treatment-Based Classification System for Low Back Pain: Revision and Update” by Muhammad Alwaily, Michael Timko, Michael Schneider, Joel Stevans, Christopher Bise, Karthik Harharan, Anthony Delitto.
Alrwaily, Muhammad, Michael T, Michael Schneider, Joel Stevans, Christopher Bise, Karthik Hariharan, and Anthony Delitto. “Treatment-Based Classification System for Low Back Pain: Revision and Update.” Physical Therapy 96.7 (2016): 1057-066. Web.
Timko, Michael, PT, MS, FAAOMPT. “The Treatment Based Classification System for Low Back Pain: 20 Years and Still Moving Forward.” West Penn Hospital, Pittsburgh. 13 Sept. 2016. Lecture.
– Connor McGee, DPT Class of 2019
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