We thank Rosedale et al1 for taking the time to comment on our recently published update of the treatment-based classification (TBC) system for the treatment of patients with low back pain.2 Since its first publication in 1995,3 the primary goal of the TBC has not changed: to provide clinicians with a comprehensive framework with which to select the best possible rehabilitation interventions for our patients. The TBC has always been formulated through pure scientific inquiry and, as such, has been updated regularly with new evidence that informs clinical decision making.2,4
To be clear, our recent version of the TBC is not meant to be a review or commentary on any other classification system. In our most recent assessment of the literature, we note that approaches based on singular treatment paradigms, although effective in some cases, have generally failed to provide the impact necessary to improve the overall clinical management of low back pain.5–15
The most recent update of the TBC framework recognizes the importance of triage, both at the level of the first-contact health care provider and at the level of the rehabilitation provider. Considering treatment-modifying variables, the rehabilitation provider must be able to implement interventions specific to symptom modulation, movement control, and functional optimization. To that end, variables such as psychosocial status and relative medical comorbidities must be assessed, as is the current scientific consensus.16 As always, we look forward to updating the TBC with the most recent evidence from the scientific community.
Footnotes
This letter was posted as an eLetter on August 12, 2016, at ptjournal.apta.org.
- © 2016 American Physical Therapy Association
