Feasibility of the subgroup criteria included in the treatment-strategy-based (TREST) classification system (CS) for patients with non-specific low back pain (NSLBP)

• Feasibility of the TREST subgroup criteria for categorization of NSLBP was explored.
• We found preliminary support for feasible criteria in TREST subgroups.
• Feasible criteria were: neurological deficits, bilateral signs and segmental signs.
• Further feasible criteria were NSLBP duration, disability and irritability.
• Further validation of the TREST is needed before advocated in clinical practice.

BackgroundThe new treatment-strategy based (TREST) classification system (CS) is in its exploratory phase with potential to impact clinical decision-making in the management of non-specific low back pain (NSLBP).ObjectiveTo evaluate the feasibility of subgroup criteria included in TREST subgroups: pain modulation, stabilization exercise, mobilization, and training.MethodsAn observational cross-sectional investigation involving a secondary analysis of data from 128 examinations of NSLBP patients, categorized individually by four examiners into one of the TREST subgroups. Four separate multivariate logistic regression analyses in two models were applied to identify how examiners applied judgments on pain intensity, disability and predetermined signs and symptoms to categorize patients into subgroups.ResultsAssociations were found between the presence of “neurological signs and symptoms” (OR 5.5, 95% CI 1.9–16), “irritability” (OR 3.0, 95% CI 3.2–20) and disability (ODI) >30 (OR 8.5, 95% CI 3–20) and the subgroup pain modulation; between the presence of “bilateral spinal signs” (OR 5.6, 95% CI 1.1–29) and the subgroup stabilization exercise; between the presence of “specific segmental signs” (OR 4.0, 95% CI 1.2–14) and ODI ≤30 (OR 0.2, 95% CI 0.1–0.6) and the subgroup mobilization; between the presence of “neurological signs and symptoms” (OR 0.2, 95% CI 0.1–0.4) and the subgroup training.ConclusionsFindings preliminary support feasibility of TREST subgroup criteria: neurological deficits, irritability, bilateral spinal signs, segmental signs and disability in the categorization of NSLBP patients. Further validation of the TREST classification system is required to establish its value in clinical reasoning and impact on patient outcomes.