Traction for Neck Pain CPR: Difference between revisions
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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. | 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=" | {| width="700" border="1" align="left" cellpadding="1" cellspacing="1" | ||
|- | |- | ||
| '''# of predictors present''' | | '''# of predictors present''' | ||
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|- | |- | ||
| <u>></u> 4 | | <u>></u> 4 | ||
| 0.30 (0.17-0.48) | | 0.30 <sub>(0.17-0.48)</sub> | ||
| 1.0 (0.91-1.0) | | 1.0 <sub>(0.91-1.0)</sub> | ||
| 23.1 (2.25-227.90) | | 23.1 <sub>(2.25-227.90)</sub> | ||
| 0.71 (0.53-0.85)<span class="Apple-tab-span" style="white-space:pre"> </span> | | 0.71<sub>(0.53-0.85)<span class="Apple-tab-span" style="white-space:pre"> </span></sub> | ||
| 94.8 | | 94.8 | ||
|- | |- | ||
| <u>></u> 3 | | <u>></u> 3 | ||
| 0.63 (0.46-0.78) | | 0.63 <sub>(0.46-0.78)</sub> | ||
| 0.87 (0.73-0.94) | | 0.87 <sub>(0.73-0.94)</sub> | ||
| 4.81 (2.17-11.4) | | 4.81 <sub>(2.17-11.4)</sub> | ||
| 0.42 (0.25-0.65) | | 0.42<sub>(0.25-0.65)</sub> | ||
| 79.2 | | 79.2 | ||
|- | |- | ||
| <u>></u> 2 | | <u>></u> 2 | ||
| 0.30 (0.17-0.48) | | 0.30 <sub>(0.17-0.48)</sub> | ||
| 0.97 (0.87-1.00) | | 0.97 <sub>(0.87-1.00)</sub> | ||
| 1.44 (1.05-2.03) | | 1.44 <sub>(1.05-2.03</sub>) | ||
| 0.40 (0.16-0.90) | | 0.40 <sub>(0.16-0.90)</sub> | ||
| 53.2 | | 53.2 | ||
|- | |- | ||
| <u>></u> 1 | | <u>></u> 1 | ||
| 0.07 (0.02-0.21) | | 0.07 <sub>(0.02-0.21)</sub> | ||
| 0.97 (0.87-1.00) | | 0.97 <sub>(0.87-1.00)</sub> | ||
| 1.15 (0.97-1.4) | | 1.15 <sub>(0.97-1.4)</sub> | ||
| 0.21 (0.03-1.23) | | 0.21 <sub>(0.03-1.23)</sub> | ||
| 47.6 | | 47.6 | ||
|} | |} |
Revision as of 06:37, 12 December 2009
Original Editor - Miwa Matsumoto
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
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 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]
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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 (%) |
> 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
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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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