{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T09:00:04Z","timestamp":1791622804891,"version":"4.3.4"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000133","name":"US Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS027426"],"award-info":[{"award-number":["R01HS027426"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000862","name":"Doris Duke Charitable Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000862","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Low back pain accounts for nearly 4 million annual emergency department (ED) visits, and patient outcomes following an ED visit for low back pain are poor. Additionally, only a small portion of patients visiting the ED for low back pain follow up with outpatient physical therapy within 3\u00a0months, despite established benefits of early versus delayed physical therapy referral such as improved patient outcomes, less opioid use, and reduced downstream health care utilization. Integrating a physical therapist directly into the ED care team can facilitate evidence-based guideline concordant care and improve patient outcomes, however, physical therapists who are staffed into this role from other settings may lack experience with evaluating and managing patients with acute low back pain. Additionally, there are several unique considerations of the ED care environment which may make existing treatment-based classification approaches difficult to apply in this setting, including physical constraints (eg, delivering care in stretchers and hallways), higher symptom severity and psychosocial stressors necessitating an emergency visit, and greater likelihood of alternative medical diagnoses (eg, kidney stone, aortic aneurysm) contributing to symptoms of low back pain. This perspective presents a modified ED treatment-based classification system (ED-TBC) for low back pain with 3 illustrative case examples. The ED-TBC for low back pain can be used to facilitate guideline concordant care, increase physical therapist confidence in evaluating low back pain in the ED, and reduce clinical practice variation.<\/jats:p>","DOI":"10.1093\/ptj\/pzaf016","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T23:23:51Z","timestamp":1739489031000},"source":"Crossref","is-referenced-by-count":3,"title":["Application of Algorithm-Based Treatment Approach to Low Back Pain in the Emergency Department"],"prefix":"10.1093","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3937-5500","authenticated-orcid":false,"given":"Kyle J","family":"Strickland","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Services, Northwestern Memorial Hospital , Chicago, IL 60611 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1934-4829","authenticated-orcid":false,"given":"Howard S","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Northwestern University Feinberg School of Medicine , Chicago, IL 60611 ,","place":["United States"]},{"name":"Center for Health Services & Outcomes Research, Northwestern University Feinberg School of Medicine , Chicago, IL 60611 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4272-1354","authenticated-orcid":false,"given":"Amee L","family":"Seitz","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy & Human Movement Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL 60611 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,14]]},"reference":[{"issue":"8","key":"2026032805190366600_ref1","doi-asserted-by":"publisher","first-page":"1492","DOI":"10.1016\/j.ajem.2018.05.053","article-title":"Physical therapy in the emergency department: a new opportunity for collaborative care","volume":"36","author":"Kim","year":"2018","journal-title":"Am J Emerg Med"},{"issue":"3","key":"2026032805190366600_ref2","doi-asserted-by":"publisher","first-page":"221","DOI":"10.2519\/jospt.2009.2857","article-title":"The physical therapist as a musculoskeletal specialist in the emergency department","volume":"39","author":"Lebec","year":"2009","journal-title":"J Orthop Sports Phys Ther"},{"issue":"1","key":"2026032805190366600_ref3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jphys.2015.11.001","article-title":"Establishing the diverse value of the emergency department physiotherapist","volume":"62","author":"Lefmann","year":"2016","journal-title":"J Physiother"},{"issue":"3","key":"2026032805190366600_ref4","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzaa219","article-title":"A prospective observational study of emergency department-initiated physical therapy for acute low back pain","volume":"101","author":"Kim","year":"2021","journal-title":"Phys Ther"},{"issue":"2","key":"2026032805190366600_ref5","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.annemergmed.2022.12.028","article-title":"Patient perspectives on seeking emergency Care for Acute low back pain and access to physical therapy in the emergency department","volume":"82","author":"Kim","year":"2023","journal-title":"Ann Emerg Med"},{"issue":"9","key":"2026032805190366600_ref6","doi-asserted-by":"publisher","first-page":"1150","DOI":"10.1093\/ptj\/pzz082","article-title":"Benefits of musculoskeletal physical therapy in emergency departments: a systematic review","volume":"99","author":"Matifat","year":"2019","journal-title":"Phys Ther"},{"issue":"4","key":"2026032805190366600_ref7","doi-asserted-by":"publisher","first-page":"e0231476","DOI":"10.1371\/journal.pone.0231476","article-title":"Dedicated emergency department physical therapy is associated with reduced imaging, opioid administration, and length of stay: a prospective observational study","volume":"15","author":"Pugh","year":"2020","journal-title":"PLoS One"},{"issue":"8","key":"2026032805190366600_ref8","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1111\/acem.14237","article-title":"Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: results of a randomized controlled trial","volume":"28","author":"Gagnon","year":"2021","journal-title":"Acad Emerg Med"},{"issue":"9","key":"2026032805190366600_ref9","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzad067","article-title":"First provider seen for an acute episode of low back pain influences subsequent health care utilization","volume":"103","author":"Bise","year":"2023","journal-title":"Phys Ther"},{"issue":"10","key":"2026032805190366600_ref10","doi-asserted-by":"publisher","first-page":"1782","DOI":"10.1093\/ptj\/pzaa100","article-title":"Time between an emergency department visit and initiation of physical therapist intervention: health care utilization and costs","volume":"100","author":"Magel","year":"2020","journal-title":"Phys Ther"},{"key":"2026032805190366600_ref11","doi-asserted-by":"publisher","first-page":"(9):37","DOI":"10.1016\/j.ajem.2022.06.048","article-title":"Emergency department evaluation, treatment, and functional outcomes among patients presenting with low back pain","volume":"59","author":"Magel","year":"2022","journal-title":"Am J Emerg Med"},{"issue":"11","key":"2026032805190366600_ref12","doi-asserted-by":"publisher","first-page":"2823","DOI":"10.1007\/s00586-018-5586-0","article-title":"The use of STarT BACK screening tool in emergency departments for patients with acute low back pain: a prospective inception cohort study","volume":"27","author":"Medeiros","year":"2018","journal-title":"Eur Spine J"},{"issue":"8","key":"2026032805190366600_ref13","first-page":"1","article-title":"Emergency department visit rates by selected characteristics: United States, 2021","volume":"478","author":"Cairns","year":"2023","journal-title":"NCHS Data Brief"},{"issue":"1","key":"2026032805190366600_ref14","doi-asserted-by":"publisher","first-page":"197","DOI":"10.3233\/BMR-170806","article-title":"Clinical predictors of the medical interventions provided to patients with low back pain in the emergency department","volume":"31","author":"Kohns","year":"2018","journal-title":"J Back Musculoskelet Rehabil"},{"issue":"5","key":"2026032805190366600_ref15","doi-asserted-by":"publisher","first-page":"e061283","DOI":"10.1136\/bmjopen-2022-061283","article-title":"Embedded emergency department physical therapy versus usual care for acute low back pain: a protocol for the NEED-PT randomised trial","volume":"12","author":"Kim","year":"2022","journal-title":"BMJ Open"},{"issue":"6","key":"2026032805190366600_ref16","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1093\/ptj\/75.6.470","article-title":"A treatment-based classification approach to low back syndrome: identifying and staging patients for conservative treatment","volume":"75","author":"Delitto","year":"1995","journal-title":"Phys Ther"},{"issue":"6","key":"2026032805190366600_ref17","doi-asserted-by":"publisher","first-page":"290","DOI":"10.2519\/jospt.2007.2498","article-title":"Subgrouping patients with low back pain: evolution of a classification approach to physical therapy","volume":"37","author":"Fritz","year":"2007","journal-title":"J Orthop Sports Phys Ther"},{"issue":"6","key":"2026032805190366600_ref18","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1097\/01.brs.0000202807.72292.a8","article-title":"Identifying subgroups of patients with acute\/subacute ``nonspecific'' low back pain: results of a randomized clinical trial","volume":"31","author":"Brennan","year":"2006","journal-title":"Spine (Phila Pa 1976)"},{"issue":"12","key":"2026032805190366600_ref19","doi-asserted-by":"publisher","first-page":"920","DOI":"10.7326\/0003-4819-141-12-200412210-00008","article-title":"A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study","volume":"141","author":"Childs","year":"2004","journal-title":"Ann Intern Med"},{"issue":"13","key":"2026032805190366600_ref20","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.1097\/01.BRS.0000067115.61673.FF","article-title":"Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial","volume":"28","author":"Fritz","year":"2003","journal-title":"Spine (Phila Pa 1976)"},{"issue":"7","key":"2026032805190366600_ref21","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.2522\/ptj.20150345","article-title":"Treatment-based classification system for low back pain: revision and update","volume":"96","author":"Alrwaily","year":"2016","journal-title":"Phys Ther"},{"issue":"4","key":"2026032805190366600_ref22","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1016\/j.math.2012.03.013","article-title":"Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (+\/\u2212 leg) pain","volume":"17","author":"Smart","year":"2012","journal-title":"Man Ther"},{"issue":"4","key":"2026032805190366600_ref23","doi-asserted-by":"publisher","first-page":"A1","DOI":"10.2519\/jospt.2012.42.4.A1","article-title":"Low back pain","volume":"42","author":"Delitto","year":"2012","journal-title":"J Orthop Sports Phys Ther."},{"issue":"11","key":"2026032805190366600_ref24","doi-asserted-by":"publisher","first-page":"2629","DOI":"10.1097\/j.pain.0000000000002324","article-title":"Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system","volume":"162","author":"Kosek","year":"2021","journal-title":"Pain"},{"issue":"15","key":"2026032805190366600_ref25","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10153203","article-title":"Nociplastic pain criteria or recognition of central sensitization? Pain phenotyping in the past, present and future","volume":"10","author":"Nijs","year":"2021","journal-title":"J Clin Med"},{"issue":"5","key":"2026032805190366600_ref26","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1002\/art.23563","article-title":"A primary care back pain screening tool: identifying patient subgroups for initial treatment","volume":"59","author":"Hill","year":"2008","journal-title":"Arthritis Rheum"},{"issue":"3","key":"2026032805190366600_ref27","doi-asserted-by":"publisher","first-page":"321","DOI":"10.2522\/ptj.20120207","article-title":"The STarT back screening tool and individual psychological measures: evaluation of prognostic capabilities for low back pain clinical outcomes in outpatient physical therapy settings","volume":"93","author":"Beneciuk","year":"2013","journal-title":"Phys Ther"},{"issue":"1","key":"2026032805190366600_ref28","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.math.2009.07.005","article-title":"Clinical indicators of 'nociceptive', 'peripheral neuropathic' and 'central' mechanisms of musculoskeletal pain. A Delphi survey of expert clinicians","volume":"15","author":"Smart","year":"2010","journal-title":"Man Ther"},{"issue":"8","key":"2026032805190366600_ref29","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1097\/AJP.0b013e318215f16a","article-title":"The discriminative validity of \"nociceptive,\" \"peripheral neuropathic,\" and \"central sensitization\" as mechanisms-based classifications of musculoskeletal pain","volume":"27","author":"Smart","year":"2011","journal-title":"Clin J Pain"},{"issue":"6","key":"2026032805190366600_ref30","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/j.jpain.2014.03.005","article-title":"Report of the NIH task force on research standards for chronic low back pain","volume":"15","author":"Deyo","year":"2014","journal-title":"J Pain"},{"issue":"1","key":"2026032805190366600_ref31","doi-asserted-by":"publisher","first-page":"8","DOI":"10.7326\/M20-4187","article-title":"Physical therapy referral from primary Care for Acute Back Pain with sciatica: a randomized controlled trial","volume":"174","author":"Fritz","year":"2021","journal-title":"Ann Intern Med"},{"issue":"14","key":"2026032805190366600_ref32","doi-asserted-by":"publisher","first-page":"1459","DOI":"10.1001\/jama.2015.11648","article-title":"Early physical therapy vs usual Care in Patients with recent-onset low back pain: a randomized clinical trial","volume":"314","author":"Fritz","year":"2015","journal-title":"JAMA"},{"issue":"6","key":"2026032805190366600_ref33","doi-asserted-by":"publisher","first-page":"CD007612","DOI":"10.1002\/14651858.CD007612.pub2","article-title":"Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica","volume":"16","author":"Dahm","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"2026032805190366600_ref34","doi-asserted-by":"publisher","first-page":"e847","DOI":"10.1097\/PR9.0000000000000847","article-title":"Psychologically informed physical therapy for musculoskeletal pain: current approaches, implications, and future directions from recent randomized trials","volume":"5","author":"Coronado","year":"2020","journal-title":"Pain Rep"},{"key":"2026032805190366600_ref35","doi-asserted-by":"publisher","first-page":"100795","DOI":"10.1016\/j.eclinm.2021.100795","article-title":"Stratified care to prevent chronic low back pain in high-risk patients: the TARGET trial. A multi-site pragmatic cluster randomized trial","volume":"34","author":"Delitto","year":"2021","journal-title":"EClinicalMedicine"},{"key":"2026032805190366600_ref36","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.msksp.2019.03.004","article-title":"Treatment monitoring as a component of psychologically informed physical therapy: a case series of patients at high risk for persistent low back pain related disability","volume":"41","author":"Beneciuk","year":"2019","journal-title":"Musculoskelet Sci Pract"},{"issue":"7","key":"2026032805190366600_ref37","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzad048","article-title":"The psychologically informed practice consultation roadmap: a clinical implementation strategy","volume":"103","author":"Main","year":"2023","journal-title":"Phys Ther"},{"issue":"9","key":"2026032805190366600_ref38","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzac091","article-title":"Patient-Centered goals after lumbar spine surgery: a secondary analysis of cognitive-Behavioral-based physical therapy outcomes from a randomized controlled trial","volume":"102","author":"Coronado","year":"2022","journal-title":"Phys Ther"},{"issue":"4","key":"2026032805190366600_ref39","doi-asserted-by":"publisher","first-page":"1\u201320","DOI":"10.21926\/obm.geriatr.1904078","article-title":"GAPcare: the geriatric acute and post-acute fall prevention intervention for emergency department patients\u2014a qualitative evaluation","volume":"3","author":"Goldberg","year":"2019","journal-title":"OBM Geriat"},{"issue":"1","key":"2026032805190366600_ref40","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1186\/s13063-019-3350-3","article-title":"Targeted interventions to prevent transitioning from acute to chronic low back pain in high-risk patients: development and delivery of a pragmatic training course of psychologically informed physical therapy for the TARGET trial","volume":"20","author":"Beneciuk","year":"2019","journal-title":"Trials"},{"issue":"12","key":"2026032805190366600_ref41","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.1001\/jama.2016.2323","article-title":"Effect of mindfulness-based stress reduction vs cognitive Behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: a randomized clinical trial","volume":"315","author":"Cherkin","year":"2016","journal-title":"JAMA"},{"issue":"6","key":"2026032805190366600_ref42","doi-asserted-by":"publisher","first-page":"391","DOI":"10.2519\/jospt.2024.12126","article-title":"Which portion of physiotherapy treatments' effect is attributable to contextual effects in people with musculoskeletal pain?: a meta-analysis of randomised placebo-controlled trials","volume":"54","author":"Ezzatvar","year":"2024","journal-title":"J Orthop Sports Phys Ther."},{"issue":"1","key":"2026032805190366600_ref43","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1111\/jgs.16210","article-title":"GAPcare: the geriatric acute and post-acute fall prevention intervention in the emergency department: preliminary data","volume":"68","author":"Goldberg","year":"2020","journal-title":"J Am Geriatr Soc"},{"issue":"1","key":"2026032805190366600_ref44","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1186\/s43058-022-00313-2","article-title":"Implementing specialised vestibular physiotherapy in an emergency department: a process evaluation","volume":"3","author":"Ip","year":"2022","journal-title":"Implement Sci Commun"}],"container-title":["Physical Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ptj\/advance-article-pdf\/doi\/10.1093\/ptj\/pzaf016\/61900418\/pzaf016.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ptj\/article-pdf\/105\/4\/pzaf016\/61900418\/pzaf016.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ptj\/article-pdf\/105\/4\/pzaf016\/61900418\/pzaf016.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T09:19:08Z","timestamp":1774689548000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ptj\/article\/doi\/10.1093\/ptj\/pzaf016\/8015729"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,14]]},"references-count":44,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ptj\/pzaf016","relation":{},"ISSN":["0031-9023","1538-6724"],"issn-type":[{"value":"0031-9023","type":"print"},{"value":"1538-6724","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2025,2,14]]},"article-number":"pzaf016"}}