Purpose:
Identify patients with low back pain who likely will improve with spinal manipulation.
Rule:
1. Duration of symptoms less than 16 days
2. At least one hip with greater than 35° of internal rotation
3. Lumbar hypomobility
4. No symptoms distal to the knee
| Item | 3+ variable | 4+ variables | 5 variables |
| SN | 0.94 | 0.63 | 0.19 |
| SP | 0.64 | 0.97 | 1.00 |
| +LR | 2.6 | 24.4 | infinite |
| -LR | |||
| POS | 68% | 95% |
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. Childs JD, et al. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med. 2004; 141(12): 920-8.
2. Cleland JA, et al. The Use of a Lumbar Spine Manipulation Technique by Physical Therapists in Patients Who Satisfy a Clinical Prediction Rule: A Case Series. J Orthop Sports Phys Ther. 2006; 36(4): 209–214.
2. Flynn T, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine. 2002; 27(24): 2835-43.
