Signs and Symptoms Originally Proposed as the Criteria for Placing a Patient Into a Particular Classification and Revised Criteria Based on Updated Evidence

L ow back pain (LBP) is the reason for seeking care in nearly 50% of all patients presenting to outpatient physical therapy clinics. 5 physical therapists employ a wide range of interventions in the management of patients with LBP, including manual physical therapy (ie, spinal manipulation), therapeutic exercise, traction, modalities, and functional training. Although a variety of interventions are accepted as standard of care for patients with LBP, 101 high-quality evidence from ran-domized clinical trials has failed to oer conclusive support for most interventions. Over 1000 random-ized clinical trials investigating the eectiveness of conservative and surgical interventions for the management of LBP have been reported in the litera-LBP has traditionally not incorporated a reality recognized by clinicians: that it is not reasonable to expect everyone with nonspecific LBP to benefit from any single treatment approach. 75 It has been advocated that researchers can improve the power of their research by using methods to match subgroups of patients to interventions from which they are likely to benefit. The lack of conclusive research evidence has provided clinicians with little information to guide decision making in the selection of interventions for individual patients, resulting in suboptimal outcomes and wide variations in practice patterns. 82,94 Clinicians agree that LBP is a heterogeneous condition, but there is disagreement as to the most appropriate methods for classifying these patients to improve clinical outcomes. 75 Traditionally the medical model has attempted to classify individuals based on a pathoanatomical source of symptoms; however, identifying relevant pathology in patients with LBP has proved elusive and is identified in less than 10% of cases. 2 Therefore, attempting to identify a pathoanatomic source will infrequently be useful for guiding decision making, particularly for physical therapists. The Guide to Physical Therapist Practice 5 recognizes that a primary goal of the diagnostic process is to classify patients based on clusters of signs and symptoms, T SYNOPSIS: The development of valid classification methods to assist the physical therapy management of patients with low back pain has been recognized as a research priority. There is also growing evidence that the use of a classification approach to physical therapy results in better clinical outcomes than the use of alternative management approaches. In 1995 Delitto and colleagues proposed a classification system intended to inform and direct the physical therapy management of patients with low back pain. The system described 4 classifications of patients with low back pain …