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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

JA Cleland, PT, PhD, OCS, FAAOMPT, is Assistant Professor, Department of Physical Therapy, Franklin Pierce College, 5 Chenell Dr, Concord, NH 03301 (USA); Research Coordinator, Rehabilitation Services, Concord Hospital, Concord, NH; and Faculty, Manual Therapy Fellowship Program, Regis University, Denver, Colo
JD Childs, PT, PhD, MBA, OCS, FAAOMPT, is Assistant Professor and Director of Research, US Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, Tex
JM Fritz, PT, PhD, ATC, is Associate Professor, Division of Physical Therapy, University of Utah, Salt Lake City, Utah, and Clinical Outcomes Research Scientist, Intermountain Health Care, Salt Lake City, Utah
JM Whitman, PT, DSc, OCS, FAAOMPT, Assistant Faculty, Department of Physical Therapy, Regis University
SL Eberhart, PT, MPT, is Physical Therapist and Clinical II, Rehabilitation Services, Concord Hospital

Address all correspondence to Dr Cleland at: clelandj{at}fpc.edu

Background and Purpose: To date, no studies have investigated the predictive validity of variables from the initial examination to identify patients with neck pain who are likely to benefit from thoracic spine thrust manipulation. The purpose of this study was to develop a clinical prediction rule (CPR) to identify patients with neck pain who are likely to experience early success from thoracic spine thrust manipulation.

Subjects: This was a prospective, cohort study of patients with mechanical neck pain who were referred for physical therapy.

Methods: Subjects underwent a standardized examination and then a series of thoracic spine thrust manipulation techniques. They were classified as having experienced a successful outcome at the second and third sessions based on their perceived recovery. Potential predictor variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for prediction of treatment success.

Results: Data for 78 subjects were included in the data analysis, of which 42 had a successful outcome. A CPR with 6 variables was identified. If 3 of the 6 variables (positive likelihood ratio=5.5) were present, the chance of experiencing a successful outcome improved from 54% to 86%.

Discussion and Conclusion: The CPR provides the ability to a priori identify patients with neck pain who are likely to experience early success with thoracic spine thrust manipulation. However, future studies are necessary to validate the rule.

This article has been cited by other articles:

				J. M Fritz and G. P Brennan Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain Physical Therapy, May 1, 2007; 87(5): 513 - 524. [Abstract] [Full Text] [PDF]

				J. A Cleland, P. Glynn, J. M Whitman, S. L Eberhart, C. MacDonald, and J. D Childs Short-Term Effects of Thrust Versus Nonthrust Mobilization/Manipulation Directed at the Thoracic Spine in Patients With Neck Pain: A Randomized Clinical Trial Physical Therapy, April 1, 2007; 87(4): 431 - 440. [Abstract] [Full Text] [PDF]