Purpose: Identify patients with mechanical neck pain who will demonstrated favorable outcomes following cervical manipulation.
Rule:
1. Symptom duration of less than 38 days
2. Positive expectation that manipulation will help
3. Side-to-side difference in cervical rotation ROM of 10° or greater
4. Pain with posteroanterior spring testing (joint play) of the middle cervical spine
| Item | 3+ variable | 4 variables |
| SN | 0.81 | 0.50 |
| SP | 0.94 | 1.00 |
| +LR | 13.5 | infinite |
| -LR | ||
| POS | 90% | 100% |
SN = sensitivity – ‘SnOut’ helps rule out a disease (higher number is better – >0.9 is excellent)
SP = Specificity – ‘SpIn’ helps rule in a disease (higher number is better – greater than 0.90 is excellent))
+LR = positive likelihood ratio – ratio of positive test results in a patients with the pathology (true positives) higher number is better (> 10 is excellent)
-LR = negative likelihood ratio – ratio of negative test results in a patients with the pathology (false negatives) lower number is better (< 0.1 is excellent)
POS = Probability of success – positive treatment outcome
References:
1. Puentedura EJ, 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; 42(7): 577-92.
