Cleland et al reported a clinical prediction rule for identifying a patient with neck pain who is likely to improve after thoracic spine manipulation. The authors are from Regis University, Baylor University, University of Utah and Concord Hospital.
Patient selection: neck pain
Exclusions: whiplash in past 6 weeks, signs of nerve root compression, neck or thoracic spine surgery
Parameters:
(1) duration of symptoms in days
(2) symptoms distal to the shoulder
(3) effect of looking up on symptoms
(4) FABQPA (Fear-Avoidance Beliefs Questionnaire physical activity subscale) score from 0 to 24
(5) upper spine kyphosis
(6) range in motions of cervical extension in degrees
Parameter
Finding
Points
symptoms
< 30 days
1
>= 30 days
0
symptoms distal to shoulder
none
1
present
0
effect of looking up
aggravates symptoms
0
does not aggravate
1
FABQPA
< 12
1
>= 12
0
upper spine kyphosis
diminished
1
not diminished
0
cervical extension ROM
< 30 degrees
1
>= 30 degrees
0
total score =
= SUM(points for all parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• A score >= 3 had a sensitivity of 76% and specificity of 86% with a pretest probability of 54%.
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