Clinical Prediction

Puentedura, Cleland JA, Landers MR, et al. Development of a Clinical Prediction Rule to Identify Patients With Neck Pain Likely to Benefit From Thrust Joint Manipulation to the Cervical Spine. J Orthop Sports Phys Ther. 2012 Jul;42(7):577-92. Epub 2012 May 14.

“A clinical prediction rule for patients with neck pain who responded favorably to cervical [thrust joint manipulation (TJM)] was developed in 2006 by Tseng et al; however, the study only addressed immediate (within-session) results, and the threshold for “success” might have been too low, as the pretest probability of success was 60%. With a pretest probability of success of 60%, and a positive likelihood ratio (+LR) of 5.33 (95% confidence interval [CI]: 1.72, 16.54) for at least 4 of 6 predictors present, the authors arrived at an 89% posttest probability of success. A +LR of 5.33 represents only a small to moderate shift in probability, and the wide CI also detracts from the clinical utility of the rule. In addition, by only assessing for an immediate response, the study failed to provide information on longer-term outcomes that would have been more indicative of a true change in condition.”Puentedura, Cleland JA, Landers MR, et al.

“We have developed a clinical prediction rule that identifies patients with neck pain who are likely to rapidly and dramatically respond to cervical spine TJM and ROM exercises. Such a clinical prediction rule will be advantageous in determining which individual patients are likely to respond (and not respond) to this treatment strategy. Future studies are necessary to validate the clinical prediction rule and determine if the use of the clinical prediction rule results in improved outcome and decreased costs in the treatment of individuals with neck pain.”Puentedura, Cleland JA, Landers MR, et al.