Traction for Neck Pain CPR: Difference between revisions
No edit summary |
No edit summary |
||
Line 10: | Line 10: | ||
A CPR with five variables was identified: | A CPR with five variables was identified: | ||
1) patient reported periperalization with lower cervical spine (C4 - 7) mobility testing, | '''1) patient reported periperalization with lower cervical spine (C4 - 7) mobility testing,''' | ||
2) positive shoulder abduction test, | '''2) positive shoulder abduction test,''' | ||
3) age <u>></u> 55, | '''3) age <u>></u> 55,''' | ||
4) positive upper limb tension test A, | '''4) positive upper limb tension test A, ''' | ||
5) positive neck distraction test | '''5) positive neck distraction test'''<br> | ||
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. | |||
<font class="Apple-style-span" size="3"><span class="Apple-style-span" style="font-size: 13px;"><font class="Apple-style-span" size="6"><span class="Apple-style-span" style="font-size: 20px;"> | <font class="Apple-style-span" size="3"><span class="Apple-style-span" style="font-size: 13px;"><font class="Apple-style-span" size="6"><span class="Apple-style-span" style="font-size: 20px;"> | ||
</span></font></span></font> | </span></font></span></font> | ||
== Combination of Predictor Variables and Associated Accuracy Statistics<ref name="Raney et al" /> <br> == | == Combination of Predictor Variables and Associated Accuracy Statistics<ref name="Raney et al" /> <br> == | ||
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. | ||
{| width="700" border="1" align="left" cellpadding="1" cellspacing="1" | {| width="700" border="1" align="left" cellpadding="1" cellspacing="1" | ||
|- | |- | ||
| # of predictors present | | '''# of predictors present''' | ||
| Sensitivity | | '''Sensitivity ''' | ||
| Specificity | | '''Specificity ''' | ||
| + LR | | '''+ LR ''' | ||
| - LR | | '''- LR ''' | ||
| Probability of success w/ cervical traction (%) | | '''Probability of success w/ cervical traction (%)''' | ||
|- | |- | ||
| <u>></u> 4 | | <u>></u> 4 | ||
| 0.30 (0.17-0.48) | | 0.30 (0.17-0.48) | ||
| 1.0 (0.91-1.0) | | 1.0 (0.91-1.0) | ||
| 23.1 (2.25-227.90) | | 23.1 (2.25-227.90) | ||
| 0.71 (0.53-0.85)<span class="Apple-tab-span" style="white-space:pre"> </span> | | 0.71 (0.53-0.85)<span class="Apple-tab-span" style="white-space:pre"> </span> | ||
| 94.8 | | 94.8 | ||
|- | |- | ||
| <u>></u> 3 | | <u>></u> 3 | ||
| 0.63 (0.46-0.78) | | 0.63 (0.46-0.78) | ||
| 0.87 (0.73-0.94) | | 0.87 (0.73-0.94) | ||
| 4.81 (2.17-11.4) | | 4.81 (2.17-11.4) | ||
| 0.42 (0.25-0.65) | | 0.42 (0.25-0.65) | ||
| 79.2 | | 79.2 | ||
|- | |- | ||
| <u>></u> 2 | | <u>></u> 2 | ||
| 0.30 (0.17-0.48) | | 0.30 (0.17-0.48) | ||
| 0.97 (0.87-1.00) | | 0.97 (0.87-1.00) | ||
| 1.44 (1.05-2.03) | | 1.44 (1.05-2.03) | ||
| 0.40 (0.16-0.90) | | 0.40 (0.16-0.90) | ||
| 53.2 | | 53.2 | ||
|- | |- | ||
| <u>></u> 1 | | <u>></u> 1 | ||
| 0.07 (0.02-0.21) | | 0.07 (0.02-0.21) | ||
| 0.97 (0.87-1.00) | | 0.97 (0.87-1.00) | ||
| 1.15 (0.97-1.4) | | 1.15 (0.97-1.4) | ||
| 0.21 (0.03-1.23) | | 0.21 (0.03-1.23) | ||
| 47.6 | | 47.6 | ||
|} | |} | ||
<br> | |||
<br> | |||
<br> | <br> | ||
<br> | |||
<br> | |||
== Description of Special Tests<br> == | |||
{| width="700" border="1" align="left" cellpadding="1" cellspacing="1" | |||
|- | |||
| '''Test''' | |||
| '''Procedure''' | |||
| '''Positive Tes'''t | |||
|- | |||
| 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: | |||
#Scapular depression | |||
#Shoulder abduction | |||
#Forearm supination | |||
#Wrist and finger extension | |||
#Shoulder external rotation | |||
#Elbow extension | |||
#Contralateral then ipsilateral cervical side bending | |||
| 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 | |||
|} | |||
== == | |||
== | == == | ||
== == | |||
== Resources == | == Resources == | ||
Line 91: | Line 118: | ||
add appropriate resources here, including text links or content demonstrating the intervention or technique | add appropriate resources here, including text links or content demonstrating the intervention or technique | ||
== | <font class="Apple-style-span" size="3"><span class="Apple-style-span" style="font-size: 13px;"><font class="Apple-style-span" size="6"><span class="Apple-style-span" style="font-size: 20px;"> | ||
</span></font></span></font> | |||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
Line 103: | Line 129: | ||
References will automatically be added here, see [[Adding References|adding references tutorial]]. | References will automatically be added here, see [[Adding References|adding references tutorial]]. | ||
<references /> | <references /> <br> | ||
<br> | |||
<br> | <br> |
Revision as of 06:17, 12 December 2009
Original Editor - Your name will be added here if you created the original content for this page.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
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 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 were retained in the final regression model out of 15 potential predictor variables.
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]
[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 (%) |
> 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 |
Description of Special Tests
[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 |
[edit | edit source]
[edit | edit source]
[edit | edit source]
Resources[edit | edit source]
add appropriate resources here, including text links or content demonstrating the intervention or technique
Recent Related Research (from Pubmed)[edit | edit source]
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
References will automatically be added here, see adding references tutorial.