On "Treatment-based classification system for low back pain: revision and update." Alrwaily M, Timko M, Schneider M, et al. Phys Ther. 2016;96:1057-1066.

Abstract

The update of the treatment-based classification (TBC) system for low back pain (LBP) published by Alrwaily et al1 ahead of print in PTJ is an important contribution to the classification literature. The objectives of this commentary are to acknowledge the possible clinical significance of the updated 2015 TBC version and to highlight parallels between this version and the treatment-strategy-based classification system (TREST), presented in 20072 and subsequently evaluated for interexaminer agreement by experienced physical therapists not previously familiar with the approach3 and recently assessed regarding the feasibility of the included subgroup criteria.4 To aid decisions concerning appropriate management of LBP, the updated version of TBC has 2 levels of triage: the level of the first-contact health care provider and the level of the rehabilitation provider. Some countries, such as Sweden, implement a system that involves direct access to physical therapy. This practice is patient-centered in that it allows patients themselves to seek health care providers who they consider to be appropriate for their particular disorders, which accordingly makes physical therapists both the first health care contact and the rehabilitation provider in many cases of nonspecific low back pain (NSLBP). This places great responsibility on a physical therapist, not only to decide on appropriate physical therapist interventions (eg, whether the measures should entail self-management or be provided by the physical therapist), but also to recognize serious spinal pathology (“red flags”) and psychological comorbidities (“yellow flags”) and, in some cases, to offer patients advice about suitable care. The manner in which this is done probably varies substantially, and hence the clear guidelines regarding what to identify and evaluate, as outlined …