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 | |||||
| Sub-classification Method | Patho-anatomical | Movement & Motor Function | PSF & Psycholog | Pain Mechanisms | CNS Coordination |
| Questionnaire | Unknown Subjective Hx | Symptom Aggravating & Easing Factor Questionnaire | STarT Back Battery of questionnaires | NRISK© S-LANSS Body Image Drawing KVIQ | MCAQ© |
| Physical Assessment | See; 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
KVIQ
Kinaesthetic and Visual Imagery Questionnaire
Registration required
NRISQ©
Neuromuscular Rehabilitation Institute Screening Questionnaire1
Licence required (can be obtained on SMARTErehab courses)
MCAQ©
Motor Control Abilities Questionnaire
Licence required (can be obtained on SMARTErehab courses)
S-LANSS
Self Administered Leeds Assessment of Neuropathic Signs and Symptom
S-LANSS Pain Score
STarT Back
http://www.keele.ac.uk/sbst/
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
Distress
Psychosocial Factors
- Orebro Musculoskeletal Screening Questionnaire
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