Clinical Presentation and Treatment Outcomes of Children and Adolescents with Low Back Pain in Physical Therapy

Purpose: Low back pain (LBP) is a common condition in adolescents, and a specific pathoanatomical origin for the symptoms cannot always be determined. The purpose of this work was to examine the clinical presentation and outcomes of rehabilitation for adolescents with LBP. Methods: This study was completed in three phases. Phase 1 was a retrospective review of 25 patients under the age of 18 who were seen for treatment of LBP. Information regarding the patients' diagnoses, history, examination, and outcome were collected from chart review. Phase 2 was a review of 99 patients under the age of 18 with LBP. Numerical Pain Rating Scale (NPRS) and the Modified Oswestry Questionnaire (OSW) were recorded. Phase 3 consisted of a prospective study of treatment-based classification (TBC) of 34 adolescent patients seen in physical therapy for LBP. Treatment duration and content were at the clinician's discretion. Patients completed an OSW and NPRS before and after physical therapy. Patients were classified using a TBC algorithm, and effectiveness of classification on outcome was examined. Results: In study 1, initial pain scores were lower if a specific pathology was present (P=.001). Initial pain and OSW scores were poorly correlated (r= 0.16). 44% (n=11) of patients scored under the floor value of 12% on OSW. A second examination of the OSW in study 2 concluded that OSW was moderately correlated with NPRS (0.59). Chronbach's alpha was 0.86. All 10 items in OSW appeared to load onto two latent factors. In study 3, a classification decision was able to be made with a moderate degree of reliability (0.53 (0.28, 0.79) ≤ κ ≤ 0.89 (.74, 1.0)) in all of the 34 patients. Stabilization was the most commonly prescribed treatment by clinicians. Those who were matched to their TBC classification experienced fewer numbers of visits than those who were not. Conclusions: It appears the OSW is a valid and reliable tool for assessing clinical outcome of physical therapy intervention for adolescents with LBP. These results also suggest that a TBC approach to treatment of LBP in this population may be effective for improvements in clinical outcome