Dennis L. Hart, FOTO®’s Director of Consulting and Research, receives national honors for research.
Dennis
L. Hart, PhD, PT, co-author and FOTO®’s Director of Consulting and Research,
and Mark W. Werneke, MS, PT, Dip. MDT, author and Physical Therapist at the
Rehabilitation and Spine Center at CentraState Medical Center received the 2005 Chattanooga
Research Award in recognition of the best clinical research article published in
the journal Physical Therapy entitled, “Categorizing patients with
occupational low back pain by use of the Quebec Task Force Classification System
versus Pain Pattern Classification procedures: discriminant and predictive
validity”, which appeared in Physical Therapy 2004;84(3):243-254.
Mr.
Werneke and Dr. Hart examined two patient classifications procedures, the Quebec
Task Force Classification (QTFC) and Pain Pattern Classification (PPC), which
are common classification procedures for patients with acute work-related low
back pain syndromes. Classification was done to estimate validity of data
obtained with QTFC and PPC procedures for differentiating patient subgroups at
intake and for use in predicting rehabilitation outcomes at discharge and work
status at 1 year after discharge from rehabilitation. Patients (n=171) with
acute work-related low back pain referred for physical therapy were analyzed.
Patients completed pain and psychosocial questionnaires at initial evaluation
and discharge and pain diagrams throughout treatment. Physical therapists
classified patients using QTFC and PPC data at intake. Patients were classified
again at discharge by PPC (time-dependent PPC).
Their
results demonstrated QTFC and PPC data could be used to differentiate patients
by pain intensity and/or disability at intake. Intake PPC predicted pain
intensity and disability at discharge, but QTFC did not. PPC predicted work
status at 1 year, but QTFC did not. Classifying patients over time using
time-dependent PPC data reduced the false positive rate by 31% and increased
percentage of change in pretest-posttest probability of return to work by 16%
compared with classifying patients at intake.
The
authors concluded the results supported the discriminant validity of the QTFC at
intake and predictive validity of the PPC at intake. However, tracking PPC over
time increased the predictive validity for 1-year work status, and therefore
strongly supported that tracking patient classification over time during
treatment using PPC is recommended compared to classifying patients only at
initial evaluation if prediction of long-term outcomes is important.
Dr.
Hart (co-author) along with Mr. Werneke (author) and David Cook (co-author)
also received the Orthopaedic Section of the American Physical Therapy
Association’s 1999 Rose Excellence in Research award for excellence in
Orthopaedic Physical Therapy Research for their article, “A descriptive study
of the centralization phenomenon”, which appeared in Spine
1999;24(7):676-683.
Mr.
Werneke, Dr. Hart and Mr. Cook investigated the occurrence and treatment
responses associated with the centralization phenomenon in 289 patients with
acute neck and back pain syndromes. The purpose of the study was to document
symptom changes to mechanical assessment during initial evaluation and during
consecutive visits. When they standardized operational definitions of clinical
examination and classification techniques, patients were reliably categorized
into 3 inclusive and mutually exclusive pain pattern groups: centralization,
non-centralization and partial reduction. This was important because
centralization has been reported to occur with high frequency during mechanical
assessments of patients with acute spinal syndromes and when centralization is
observed, a favorable treatment result is expected. Because centralization has
not been consistently defined in the literature, the true prevalence and
treatment responses associated with centralization have not been confirmed.
The
results demonstrated that patients could be reliably categorized according to
movement signs and symptoms. The centralization pain pattern group had
significantly fewer visits than the other two groups. Pain intensity rating and
perceived function were different between the centralization and
non-centralization groups. There was no difference in treatment responses
between the centralization and partial reduction groups. Prevalence of the three
groups was: centralization (30.8%), non-centralization (23.2%), and the partial
reduction group (46%).
The
authors concluded that categorization by changes in pain location to mechanical
assessment and treatment allowed identification of patients with improved
treatment outcomes and facilitated planning of conservative management of
patients with acute spinal pain syndromes. In other words, classification of
these patients allowed better grouping of patients for better treatment
management and better prediction of outcomes. If a proximal change in pain
location is not observed by the 7th treatment visit, their results support
additional medical evaluation, either for physical or non-physical factors,
which could be delaying quick resolution of the acute episode.