Intervertebral Disc Hydration Management: An Integrated Biomedical and Biopsychosocial Approach to Low Back Pain

Presenter: 
S. Christopher Owens, PT, BS, ScD

Description: An estimated 84% of the population will experience an acute episode of low back pain during their lifetime. Physical therapists have favorable attitudes toward integrating a biopsychosocial approach to the management of chronic non-specific low back pain. However, the challenge that arises from these beliefs is how to integrate biopsychosocial approaches with traditional biomedical models.

The purpose of this presentation is to provide clinicians with an approach to the examination and treatment of patients with low back pain that emphasizes both structural and biopsychosocial aspects of this condition. I will present an evidence-based practice model that uses research findings focused on intervertebral disc hydration, clinical experience and biopsychosocial considerations to guide a systematic approach to examination and interventions for patients with persistent low back pain.

• Describe the biomechanical and neurological contributions to lumbar discogenic pain.
• Describe the influence of psychosocial issues on lumbar discogenic pain.
• Evaluate clinical information in order to provide patient education on intervertebral disc loading and selected recovery postures and strategies.
• Provide intervention strategies that emphasize lumbar intervertebral hydration based on current clinical evidence.

Early Identification and Diagnosis of Axial Spondyloarthritis (EIDA)

Presenter: Dr. Dax G. Rumsey

Description: Axial Spondyloarthritis is an often-overlooked cause of chronic back pain. The EIDA Project raises awareness and educates non-rheumatologists about clinical features that may suggest the presence of axial Spondyloarthritis. The goal of this program is to shorten the diagnostic delay, which is currently 5-8 years on average, by increasing awareness and knowledge of axial spondyloarthritis (axSpA) among non-rheumatology healthcare professionals who are caring for patients with chronic back pain to promote the timely referral of patients. Our ultimate goal is to improve long-term outcomes in axSpA by reducing the time from symptom onset to diagnosis and to provide patients with the benefits of early effective therapy.

• Develop an awareness of axSpA as treatable cause of back pain.
• Recognize an inflammatory back pain pattern as a typical presentation of axSpA.
• Identify other common clinical features of axSpA that occur outside the spine.
• Gain knowledge of basic principles of diagnosis and treatment of axSpA as applied by rheumatologists.
• Understand appropriate testing for a patient with chronic back pain suspected of axSpA and apply criteria for referral to rheumatology.

Interdisciplinary Strategies in Lower Limb Orthotic Prescription

Presenters:
William Riddick, PT, DPT
Board-Certified Clinical Specialist in Geriatric Physical Therapy

Kris Desjardins, CPO, FAAOP(D)

Kierstan Gastrock, PT, DPT

Description: This course will focus on interdisciplinary practice in lower limb orthotics with a focus on orthotist-physical therapist collaboration. We will review the orthotist’s scope of practice, and the various roles of professionals within integrated care models for orthotic prescription. Examples of interdisciplinary practice will be examined to support participants in creating their own model. Orthotic technology and design, orthotic selection guidelines, and common pathological mechanisms will be reviewed to support clinical decision-making for patients with lower limb pathology. This will be reinforced with a case study presented from both the orthotist and physical therapist’s perspective.

• Identify key resources related to orthotic prescription including clinical practice guidelines, workflows, and supportive documentation.
• Evaluate and identify lower limb pathology that would benefit from an orthosis.
• Identify the four core competencies for interprofessional teams established by the Interprofessional Education Collaborative (IPEC).
• Adapt and implement an integrated care model into various physical therapy clinical settings.

Sometimes Think “Zebras” – Perspectives on Clinical Reasoning in Differential Diagnosis for Non-Neuromusculoskeletal Screening

Presenter:
Joey Bikkers, PT, DPT
Board-Certified Clinical Specialist in Orthopaedic Physical Therapy

Description: This presentation will focus on clinical reasoning in orthopaedic manual physical therapy in the context of differential diagnosis, medical screening, and course of action for cases which appear to not be neuromusculoskeletal (NMSK) in nature. The presentation will explore common errors in heuristics and clinical reasoning before diving into non-NMSK differential diagnosis, using a case-based format to introduce concepts involved in diagnostic testing to support or refute your differentials. Participants are encouraged to engage and interact in case-based discussions, as well as to ask questions pertaining to the subject matter in order to enhance their confidence with medical screening in clinical practice. This presentation will focus on cases involving screening for and decision making involving rheumatology, cardiology, and oncology.

• Discuss common heuristics and clinical reasoning errors and provide examples.
• Generate a differential diagnosis list as based on patient symptom locations, history, and subjective/physical exam features.
• Use relevant literature to substantiate the reasoning suggesting an increased or reduced likelihood/suspicion of a neuromusculoskeletal (NMSK).
• Verbalize reason for non-NMSK differential and recommended follow-up action to rule this hypothesis out.