###### Abstract  
The non-specific nature of low back pain (LBP) poses challenges in its diagnosis and clinical management. Classifying case complexity with an exercise method may help overcome these challenges. The present study proposed a movement-based classification system based on Dance Medicine Australia (DMA) Clinical Pilates for patients with non-specific chronic LBP. To test the feasibility of the proposed system, 40 adults with non-specific chronic LBP were assessed on their movement preference (i.e., movement directions that can relieve pain or are pain-free) through the DMA Clinical Plates method. The movement preferences could be a combination of each of the following movement directions: (1) flexion or extension, (2) left or right lateral flexion and/or (3) left or right rotation. For cases that had central or bilateral pain, the number of movement preferences identified was used to guide the classification. Using the proposed system, all 40 (100%) LBP cases were successfully classified into basic (\(n\) = 8, 20%), intermediate (\(n\) = 17, 42.5%), advanced (\(n\) = 8, 20%) or expert (\(n\) = 7, 17.5%) levels of complexity. In conclusion, this study has demonstrated that the proposed movement-based classification system was a feasible method for classifying case complexity in adults with non-specific chronic LBP. Future clinical intervention studies are needed to confirm if this classification system can enhance therapeutic outcomes in patients. exercise; DMA Clinical Pilates; physiotherapy; healthcare; humbago +
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could be classified into mechanical and non-mechanical pain [9]. Mechanical pain is related to movement disorders, while non-mechanical pain is related to pathological conditions such as inflammation [9]. A recently proposed directional preference classification method based on Dance Medicine Australia (DMA) Clinical Pilates could be useful to guide exercise prescription for non-specific chronic LBP [10]. To administer the treatment, physiotherapists use directional (movement) preference to prescribe exercises that are comfortable for an individual to perform in a specific one-directional movement plane [11; 12; 13]. This DMA Clinical Pilates approach is theoretically appealing because it allows patients to exercise comfortably without having to bear the pain. The potential of movement preference in LBP management, however, has not been fully explored yet. Clinically, Pilates is rising as a popular choice to treat people with chronic LBP [14; 15]. Among the variations in Pilates methods, the DMA Clinical Pilates method is designed with an exercise testing approach using movement preference [16]. The Clinical Pilates approach uses the history of an individual and exercise testing to identify what is easy for the individual to do [10]. Despite the promising outlook in the use of movement preference, physiotherapists who were newly trained in the Clinical Pilates approach appeared to have gaps in applying the method effectively to elicit efficacy over general exercises [17]. This suggests that not all movement preferences can be identified accurately by a physiotherapist due to the potential case complexity and uniqueness of each person with non-specific chronic LBP. The multiple factors related to a patient with non-specific chronic LBP could be daunting for novice physiotherapists. Most LBP cases (90%) are non-specific and not associated with structural impairments [18; 19], so it can be very hard to pinpoint the cause and prescribe the appropriate intervention. Even if diagnostic ultrasound is a valid and reliable tool to assist in diagnosis [1], it does not provide a pathway for exercise prescription. The difficulty in identifying a cause and matching the appropriate intervention could have led to the perception that LBP cases are complex and even more challenging with increasing chronicity [20]. In addition, the common practice of motor control exercise prescription has been perceived as ambiguous [20].