Childs et al developed a clinical prediction rule for identifying a patient with low back pain who may benefit from spinal manipulation. This can help triage patients for management. The authors are from Wilford Hall Medical Center in San Antonio, the University of Pittsburgh, Fort Sam Houston, Hill Air Force Base Medical Clinic in Utah and Luke Air Force Base Medical Center in Phoenix.
Parameters:
(1) duration of current episode of low back pain
(2) extent of distal symptoms
(3) work subscale score to the Fear-Avoidance Beliefs Questionnaire (FABQ)
(4) mobility of the lumbar spine segments
(5) range of internal rotation for both hips
Parameter |
Finding |
Points |
duration of current episode |
< 16 days |
1 |
|
>= 16 days |
0 |
extent of distal symptoms |
no symptoms distal to the knee |
1 |
|
symptoms distal to the knee |
0 |
work subscale score FABQ |
< 19 points |
1 |
|
>= 19 points |
0 |
mobility of lumbar spine |
no hypomobile segments |
0 |
|
1 or more hypomobile segments |
1 |
hip internal rotation |
neither hip has an internal range of motion > 35 degrees |
0 |
|
one or both hips have an internal range of motion > 35 degrees |
1 |
where:
• The score for the work subscale of the FABQ ranges from 0 to 42.
• The specific criteria for evaluating each parameter are given in Appendix 1, page W-165.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• A score >= 4 was associated with possible benefit from spinal manipulation.
• A score <= 3 was not associated with benefit from spinal manipulation.
Performance:
• A patient who met the criteria and had manipulation had a 92% chance of a successful outcome.
Specialty: Surgery, orthopedic