Purpose: Identify patients with neck pain who are likely to experience early success from thoracic spine high velocity low amplitude thrust manipulation, exercise, and patient education.
Rule:
1. Symptoms less than 30 days
2. No symptoms distal to the shoulder
3. Looking up does not aggravate symptoms
4. FABQ score less than 12
5. Diminished upper thoracic spine kyphosis
6. Cervical extension ROM less than 30 degrees
| Item | 3+ variable | 4+ variables | 5+ variables |
| SN | |||
| SP | |||
| +LR | 5.5 | 12.0 | infinite |
| -LR | |||
| POS | 86% | 93% | 100% |
| NPV |
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. Cleland JA, et al. Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation, exercise, and patient education. Phys Ther. 2007; 87(1): 9-23.
2. Cleland JA, et al. Examination of a Clinical Prediction Rule to Identify Patients With Neck Pain Likely to Benefit From Thoracic Spine Thrust Manipulation and a General Cervical Range of Motion Exercise: Multi-Center Randomized Clinical Trial. Phys Ther. 2010; 90(9): 1239-1250.
