CPR for Cervical Radiculopathy: Difference between revisions
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== Clinical Prediction Rule<ref name="Wainner">Wainner RS, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine 2003;28(1):52-62.</ref><br> == | == Clinical Prediction Rule<ref name="Wainner">Wainner RS, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine 2003;28(1):52-62.</ref><br> == | ||
The following '''criteria''' are considered predictive of the presence of cervical radiculopathy: positive upper limb tension test A (ULTTa), involved-side cervical rotation range of motion less than 60 degrees, positive distraction test, and positive Spurling's test A. Definitions of posititive clinical test results are as follows: | The following '''criteria''' are considered predictive of the presence of cervical radiculopathy: '''positive upper limb tension test A''' (ULTTa), involved-side cervical '''rotation range of motion less than 60 degrees''', '''positive distraction test''', and '''positive Spurling's test A'''. Definitions of posititive clinical test results are as follows: | ||
1. <u>ULTTa</u>: Any one of the following: A) symptom reproduction; B) side-to-side difference >10 degrees in in elbow extension; or C) with regard to involved/painful side, ipsilateral neck lateral flexion decreases symptoms and/or contralateral neck lateral flexion increases symptoms. | 1. <u>ULTTa</u>: Any one of the following: A) symptom reproduction; B) side-to-side difference >10 degrees in in elbow extension; or C) with regard to involved/painful side, ipsilateral neck lateral flexion decreases symptoms and/or contralateral neck lateral flexion increases symptoms. | ||
Revision as of 23:38, 5 July 2009
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Purpose
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To assist in the diagnosis of cervical radiculopathy.
Clinical Prediction Rule[1]
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The following criteria are considered predictive of the presence of cervical radiculopathy: positive upper limb tension test A (ULTTa), involved-side cervical rotation range of motion less than 60 degrees, positive distraction test, and positive Spurling's test A. Definitions of posititive clinical test results are as follows:
1. ULTTa: Any one of the following: A) symptom reproduction; B) side-to-side difference >10 degrees in in elbow extension; or C) with regard to involved/painful side, ipsilateral neck lateral flexion decreases symptoms and/or contralateral neck lateral flexion increases symptoms.
2. Distraction test: symptom reduction.
3. Spurling's A: symptom reproduction.
Diagnostic values of results (95% Confidence Intervals) are as follows:
| Number of Positive Criteria | Sensitivity | Specificity | Pos LR | Neg LR* |
| Two | 0.39 (0.16-0.61) | 0.56 (0.43-0.68) | 0.88 (1.5-2.5) | 1.09 |
| Three | 0.39 (0.16-0.61) | 0.94 (0.88-1.0) | 6.1 (2.0-18.6) | 0.65 |
| Four | 0.24 (0.05-0.43) | 0.99 (0.97-1.0) | 30.3 (1.7-538.2) | 0.77 |
(Table adapted from Wainner et al 2003. Pos LR = positive likelihood ratio. Neg LR = negative likelihood ratio. *Calculated from Sn and Sp values provided in Wainner et al 2003.)
Evidence
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A clinical prediction rule (CPR) has been defined as the process by which combinations of clinical findings that have been statistically demonstrated to be meaningful predictors of a condition or outcome of interest are used to categorize a heterogenous group of patients into subgroups based on a shared likelihood of the presence of that condition or outcome.[2] Clinical prediction rules are tools that aid clinicians in clinical decision making. They are not intended as a replacement for clinical judgement; but rather are intended to be used in conjunction with clinical judgement, clinical examination, patient history, and other parts of the evaluative process to arrive at a clinically meaninful decision about diagnosis or treatment.
In 2003, Wainner and colleagues identified a CPR ("test item cluster" or "TIC" in the study) for the presence of cervical radiculopathy. Eighty-two consecutive patients across 4 medical facilities referred to the electrophysiological laboratory with suspected diagnosis of cervical radiculopathy (CR) or carpal tunnel syndrome were enrolled in their study. Various patient report and clinical examination variables were analyzed and compared to a reference criterion of needle EMG and nerve conduction study for diagnosis of CR. Binary logistical regression was used to identifiy the most accurate TIC for diagnosing CR, described above.
Resources[edit | edit source]
add any relevant resources here
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ Wainner RS, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine 2003;28(1):52-62.
- ↑ Randolph et al, cited in: Beattie P and Nelson R. Clinical prediction rules--what are they and what do they tell us? Australian J of Physiotherapy 2006;52:157-163.
