Treatment-based classification of low back pain – who are the unclear classifications?

A recent focus in low back pain research has been to identify patient subgroups that respond best to certain treatments. To integrate these subgroup findings into a useable form, a treatment-based classification algorithm for LBP was created.1,2 To allow the algorithm to be comprehensive – eg, provide a classification for all patients – additional criteria are provided to assist therapists’ decisions for patients who do not clearly meet a treatment subgroup (unclear classifications). Recent research found that approximately 34% of patients will receive unclear classifications using the algorithm.3 It has also been shown that the reliability of the classification decision for unclear classifications is poor – significant variability between raters exists.3 In addition to poor reliability, outcomes for patients receiving unclear classifications may be inferior to outcomes of those receiving clear classifications.4 Thus the aim of the present study was to determine if people receiving unclear classifications are different from those with clear classifications in the hopes to refine the classification algorithm