Traction for Neck Pain CPR: Difference between revisions
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'''Original Editor '''- [[User:Miwa Matsumoto|Miwa Matsumoto]] | '''Original Editor '''- [[User:Miwa Matsumoto|Miwa Matsumoto]] | ||
''' | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | ||
</div> | </div> | ||
== Description | == Description == | ||
Raney et al<ref name="Raney et al">Raney N, Petersen EJ, Smith TA, Cowan JE, Rendeiro DG, Deyle GD, Childs JD. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J 2009;18:382-391</ref> 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 exercises 2x/week for 3 weeks. Outcome was measured based on the global rating of change (<u>></u> ±6 were classified as having a successful outcome). Based on a significance level of ''P'' <u><</u> 0.15, five variables out of 15 potential variables were retained in the final regression model. | Raney et al<ref name="Raney et al">Raney N, Petersen EJ, Smith TA, Cowan JE, Rendeiro DG, Deyle GD, Childs JD. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J 2009;18:382-391</ref> 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 exercises 2x/week for 3 weeks. Outcome was measured based on the global rating of change (<u>></u> ±6 were classified as having a successful outcome). Based on a significance level of ''P'' <u><</u> 0.15, five variables out of 15 potential variables were retained in the final regression model. | ||
| Line 10: | Line 10: | ||
A CPR with 5 variables was identified: | A CPR with 5 variables was identified: | ||
#'''patient reported periperalization with lower cervical spine (C4 - 7) mobility testing,''' | #'''patient reported periperalization with lower cervical spine (C4-7) mobility testing,''' | ||
#'''positive shoulder abduction test,''' | #'''positive shoulder abduction test,''' | ||
#'''age <u>></u> 55,''' | #'''age <u>></u> 55,''' | ||
#'''positive upper limb tension test A, | #'''positive upper limb tension test A,''' | ||
#'''positive neck distraction test''' | #'''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. | 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<ref name="Raney et al" /> | == Combination of Predictor Variables and Associated Accuracy Statistics<ref name="Raney et al" /> == | ||
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. | 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. | ||
| Line 36: | Line 36: | ||
| '''23.1''' <sub>(2.25-227.90)</sub> | | '''23.1''' <sub>(2.25-227.90)</sub> | ||
| '''0.71''' <sub>(0.53-0.85)<span style="white-space: pre;" class="Apple-tab-span"> </span></sub> | | '''0.71''' <sub>(0.53-0.85)<span style="white-space: pre;" class="Apple-tab-span"> </span></sub> | ||
| 94.8 | | 94.8% | ||
|- | |- | ||
| <u>></u> 3 | | <u>></u> 3 | ||
| Line 43: | Line 43: | ||
| '''4.81''' <sub>(2.17-11.4)</sub> | | '''4.81''' <sub>(2.17-11.4)</sub> | ||
| '''0.42''' <sub>(0.25-0.65)</sub> | | '''0.42''' <sub>(0.25-0.65)</sub> | ||
| 79.2 | | 79.2% | ||
|- | |- | ||
| <u>></u> 2 | | <u>></u> 2 | ||
| Line 50: | Line 50: | ||
| '''1.44''' <sub>(1.05-2.03</sub>) | | '''1.44''' <sub>(1.05-2.03</sub>) | ||
| '''0.40''' <sub>(0.16-0.90)</sub> | | '''0.40''' <sub>(0.16-0.90)</sub> | ||
| 53.2 | | 53.2% | ||
|- | |- | ||
| <u>></u> 1 | | <u>></u> 1 | ||
| Line 57: | Line 57: | ||
| '''1.15''' <sub>(0.97-1.4)</sub> | | '''1.15''' <sub>(0.97-1.4)</sub> | ||
| '''0.21''' <sub>(0.03-1.23)</sub> | | '''0.21''' <sub>(0.03-1.23)</sub> | ||
| 47.6 | | 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 (e.g.) 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. | |||
<br> | <br> | ||
== Description of Special Tests<ref name="Raney et al" /> == | |||
== Description of Special Tests<ref name="Raney et al" / | |||
{| width="700" cellspacing="1" cellpadding="1" border="1" align="left" | {| width="700" cellspacing="1" cellpadding="1" border="1" align="left" | ||
|- | |- | ||
| '''Test''' | | '''Test''' | ||
| '''Procedure''' | | '''Procedure''' | ||
| '''Positive | | '''Positive Test''' | ||
|- | |- | ||
| Shoulder abduction test | | Shoulder abduction test | ||
| Line 101: | Line 85: | ||
#Contralateral then ipsilateral cervical side bending | #Contralateral then ipsilateral cervical side bending | ||
| Reproduction of | | Reproduction of Symptoms | ||
|- | |- | ||
| Neck distraction test | | Neck distraction test | ||
| Line 107: | Line 91: | ||
| Reduction or elimination of symptoms | | Reduction or elimination of symptoms | ||
|} | |} | ||
<br> | <br> | ||
== Description of Exercises<ref name="Raney et al" /><ref name="Jull et al">Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002;27:1835-1843</ref> == | |||
== Description of Exercises | |||
{| width="600" cellspacing="1" cellpadding="1" border="1" align="left" | {| width="600" cellspacing="1" cellpadding="1" border="1" align="left" | ||
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| width="500" | | | width="500" | | ||
Pt supine. Perform a slow and controlled craniocervical flexion motion without contracting the large superficial anterior neck muscles. (Hold 10 sec x 10; 2x/day) | Pt supine. Perform a slow and controlled craniocervical flexion motion without contracting the large superficial anterior neck muscles. (Hold 10 sec x 10; 2x/day) | ||
|} | |} | ||
== References == | == References == | ||
<references /> <br> | <references /> <br> | ||
[[Category:Clinical_Prediction_Rules]] [[Category:Cervical_Spine]] [[Category:Cervical Spine - Interventions]] [[Category:Interventions]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:EIM_Residency_Project]] [[Category:Primary Contact]] | |||
Latest revision as of 14:55, 23 August 2019
Original Editor - Miwa Matsumoto
Top Contributors - Miwa Matsumoto, Admin, Evan Thomas, Simisola Ajeyalemi, Kim Jackson, WikiSysop and Claire Knott
Description[edit | edit source]
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 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 5 variables was identified:
- patient reported periperalization with lower cervical spine (C4-7) mobility testing,
- positive shoulder abduction test,
- age > 55,
- positive upper limb tension test A,
- 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][edit | edit source]
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 (e.g.) 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][edit | edit source]
| 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 |
Description of Exercises[1][2][edit | edit source]
| Exercise | Procedure |
| Seated posture exercise | Pt sitting with spine in a natural lordosis. Pt retract scapulae and gently elongate the cervical spines to achieve a neutral upright postural position. (Hold 10 sec, 2x/hr) |
| DNF exercise |
Pt supine. Perform a slow and controlled craniocervical flexion motion without contracting the large superficial anterior neck muscles. (Hold 10 sec x 10; 2x/day) |
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Raney N, Petersen EJ, Smith TA, Cowan JE, Rendeiro DG, Deyle GD, Childs JD. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J 2009;18:382-391
- ↑ Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002;27:1835-1843
