Strategies for Sub-classification

Movement is the foundation for rehabilitation in musculoskeletal disorders.  The key is to identify when it is suitable to use specific movement pattern control exercise and specific motor control exercise.  We have to rule out dominant psychological and psychosocial issues, non mechanical pain mechanisms (central sensitization and central musculoskeletal body image pain), neuropathic pain (this can frequently be treated with a combined approach involving specific exercise) and poor Central Nervous System Coordination (the ability to learn specific exercise).

Table 1 summarizes the strategies used in sub-classification.  Overall, the strategies described below are over 90% accurate (average of sensitivity and specificity) to rule out the above issues to know if specific exercise is appropriate. When this is known there is a high probability of getting significant improvement using specific exercise.

Table 1: SMARTERehab sub-classification categories with strategies for diagnosis.


 Sub-classification Category  
Patho-anatomicalMovement & Motor FunctionPSF & PsychologPain MechanismsCNS Coordination
QuestionnaireUnknown Subjective HxSymptom Aggravating & Easing Factor Questionnaire STarT Back Battery of questionnaires NRISK© S-LANSS Body Image Drawing KVIQ MCAQ©
Physical AssessmentSee; Cook & Hegedus, 2011 Glynn & Weisback 2009 Assessment of functional movement pattern control & kinetic chain sequencing Neurological soft signs 
Neurological Ax ROM MTP Midline Ax
 Primitive reflex, sensory motor & midline Ax


Body Image Drawing
Licence required (can be obtained on SMARTErehab courses)

Cook C, Hegedus E 2011 Orthopedic Physical Examination Tests: An Evidence-Based Approach 2nd Ed. Prentice Hall

Glynn PE, Weisbach PC 2009 Clinical Prediction Rules: A Physical Therapy Reference Manual. Jones & Bartlett Learning

Kinaesthetic and Visual Imagery Questionnaire
Registration required

Neuromuscular Rehabilitation Institute Screening Questionnaire1
Licence required (can be obtained on SMARTErehab courses)

Motor Control Abilities Questionnaire
Licence required (can be obtained on SMARTErehab courses)

Self Administered Leeds Assessment of Neuropathic Signs and Symptom
S-LANSS Pain Score

STarT Back
Whiplash Associated Disorders
Impact of Events Scale

Battery of questionnaires
Anxiety and Depression

  • Hospital Anxiety and Depression Scale
  • Beck's Anxiety Inventory
  • Beck's Depression Inventory

Fear of movement

  • Fear Avoidance Beliefs Questionnaire
  • Tampa Scale of Kinesiophobia


Psychosocial Factors

  • Orebro Musculoskeletal Screening Questionnaire
Symptom Aggravating & Easing Factor Questionnaire

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