Reviewing the Diagnostic Classifications used for Low Back Pain in Physiotherapy-related Research.

Abstract

Background: The evidence-to-practice gap, where clinical practice does not reflect the findings from research evidence, has been identified as a concern in allied health disciplines such as physiotherapy. Failure to provide care according to current (research) evidence raises the potential that patients are receiving care that is either not needed, is ineffective, less effective than current research indicates, or potentially harmful. For research evidence to be translatable to clinical practice, the research should be seen to be applicable, i.e. the clinician should be able to recognise that the research study sample reflects their patient population. Method: This study presents a pragmatic clinical review of patient sampling from high level primary research trials investigating physical therapy for low back pain. Only studies where full text copies were freely accessible to clinicians were reviewed. The review collated the characteristics of the study subjects and explored how they related to standard clinical practice. Results: A total of 63 full text randomised controlled trials papers were identified and reviewed. Across the studies reviewed, the clinical presentations of included subjects were variably described, with inconsistencies in the diagnostic labels used, the characteristics of the symptoms reported and the nature of the exclusion criteria applied. Of concern was the lack of reporting of patient’s clinical presentation according to standard clinical assessment findings to allow the clinician to gauge the applicability of the study. Conclusion: A core principle of clinical physiotherapy practice is the clinical assessment of the patient to identify the patient’s specific presentation to individualise rehabilitation and exclude serious pathology. To close the evidence-practice gap, we either need to revisit standard clinical practice or focus on the reporting of the research evidence to ensure its applicability.