Traction for Neck Pain CPR: Difference between revisions
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| width=" | | width="120" | '''Specificity ''' | ||
| width=" | | width="120" | '''+ LR ''' | ||
| width=" | | width="120" | '''- LR ''' | ||
| '''Probability of success w/ cervical traction + exercise''' | | '''Probability of success w/ cervical traction + exercise''' | ||
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*Having at least 3 out of 5 predictors appears to be the optimal threshold for choosing the cervical traction as an intervention. | |||
*Having at least 3 out of 5 predictors appears to be the optimal threshold for choosing the cervical traction as an intervention. | |||
*Having fewer than 2 predictors might indicate a sub-group who would preferentially benefit from a different intervention (eg) pt had 1/5 predictor variables, the post-test probability of success with cervical traction and exercise is only 47.5%, less than a chance. | *Having fewer than 2 predictors might indicate a sub-group who would preferentially benefit from a different intervention (eg) pt had 1/5 predictor variables, the post-test probability of success with cervical traction and exercise is only 47.5%, less than a chance. | ||
Revision as of 18:37, 12 December 2009
Original Editor - Miwa Matsumoto
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Description
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Raney et al[1] developed a Clinical Prediction Rule (CPR) for identifying patients with neck pain likely to respond to mechanical cervical traction. Eighty patients with neck pain received 6 sessions of intermittent cervical traction and cervical strengthening exercises 2x/week for 3 weeks. Outcome was measured based on the global rating of change (> ±6 were classified as having a successful outcome). Based on a significance level of P < 0.15, five variables out of 15 potential variables were retained in the final regression model.
A CPR with five variables was identified:
1) patient reported periperalization with lower cervical spine (C4 - 7) mobility testing,
2) positive shoulder abduction test,
3) age > 55,
4) positive upper limb tension test A,
5) positive neck distraction test
Although a following validation study is warranted, this preliminary CPR provides the ability for a clinician to identify the sub-group of patients with neck pain who would most likely to benefit from cervical traction and exercise.
Combination of Predictor Variables and Associated Accuracy Statistics[1]
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The probability of successful outcome after cervical traction is calculated using the + LR and pretest probability of 44% (30 out of 68 patients). Accuracy statistics with 95% CI for individual variables for predicting success with cervical traction.
| # of predictors present | Sensitivity | Specificity | + LR | - LR | Probability of success w/ cervical traction + exercise |
| > 4 | 0.30 (0.17-0.48) | 1.0 (0.91-1.0) | 23.1 (2.25-227.90) | 0.71 (0.53-0.85) | 94.8 % |
| > 3 | 0.63 (0.46-0.78) | 0.87 (0.73-0.94) | 4.81 (2.17-11.4) | 0.42 (0.25-0.65) | 79.2 % |
| > 2 | 0.30 (0.17-0.48) | 0.97 (0.87-1.00) | 1.44 (1.05-2.03) | 0.40 (0.16-0.90) | 53.2 % |
| > 1 | 0.07 (0.02-0.21) | 0.97 (0.87-1.00) | 1.15 (0.97-1.4) | 0.21 (0.03-1.23) | 47.6 % |
- Having at least 3 out of 5 predictors appears to be the optimal threshold for choosing the cervical traction as an intervention.
- Having fewer than 2 predictors might indicate a sub-group who would preferentially benefit from a different intervention (eg) pt had 1/5 predictor variables, the post-test probability of success with cervical traction and exercise is only 47.5%, less than a chance.
Description of Special Tests[1]
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| Test | Procedure | Positive Test |
| Shoulder abduction test | Pt in sitting position. Pt is instructed to place the hand of the affected extremity on the head in order to support the extremity in the scapular plane | Alleviation of symptoms |
| Upper limb tension test (ULTT A) |
Pt supine. Examiner sequentially introduces the following movements to the symptomatic UE:
|
Reproduction of symptoms |
| Neck distraction test | Pt supine w/ neck comfortably positioned. Examiner securely grasps the pt's head under the occiput and chin and gradually applies an axial traction force up to approximately 30 pounds. | Reduction or elimination of symptoms |
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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