Traction for Neck Pain CPR: Difference between revisions
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<div class="editorbox"> | [[Category:Articles]] [[Category:Cervical]] [[Category:EIM Student Project 2]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Intervention]][[Category:Clinical Prediction Rules]] <div class="editorbox"> | ||
'''Original Editor '''- Miwa Matsumoto | '''Original Editor '''- [[User:Miwa Matsumoto|Miwa Matsumoto]] | ||
'''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | ||
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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,''' | ||
#'''positive shoulder abduction test,''' | |||
''' | #'''age <u>></u> 55,''' | ||
#'''positive upper limb tension test A, ''' | |||
''' | #'''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 size="3" class="Apple-style-span"><span class="Apple-style-span" style="font-size: 13px;"><font size="6" class="Apple-style-span"><span class="Apple-style-span" style="font-size: 20px;"> | |||
</span></font></span></font>Combination of Predictor Variables and Associated Accuracy Statistics<ref name="Raney et al" /> <br> == | |||
<font class="Apple-style-span | |||
</span></font></span></font> | |||
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. | ||
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| '''# of predictors present''' | | '''# of predictors present''' | ||
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| '''1.0''' <sub>(0.91-1.0)</sub> | | '''1.0''' <sub>(0.91-1.0)</sub> | ||
| '''23.1''' <sub>(2.25-227.90)</sub> | | '''23.1''' <sub>(2.25-227.90)</sub> | ||
| '''0.71''' <sub>(0.53-0.85)<span class="Apple-tab-span" style="white-space:pre"> </span></sub> | | '''0.71''' <sub>(0.53-0.85)<span class="Apple-tab-span" style="white-space: pre;"> </span></sub> | ||
| 94.8 % | | 94.8 % | ||
|- | |- | ||
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| 47.6 % | | 47.6 % | ||
|} | |} | ||
<br> | <br> | ||
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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. <br> | ||
<br> | |||
= Description of Special Tests<ref name="Raney et al" /><br> = | = Description of Special Tests<ref name="Raney et al" /><br> = | ||
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| '''Test''' | | '''Test''' | ||
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</span></font></span></font> | </span></font></span></font> | ||
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= 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 <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> = | ||
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| '''Exercise''' | | '''Exercise''' | ||
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= Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) = | = Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) = | ||
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<rss> | <rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1lMnN-9mhA8gWPI35qfd79hgcfHKkhyU4DN_yL9LmnHMHZDkHL|charset=UTF-8|short|max=10</rss> | ||
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= References = | = References = |
Revision as of 13:59, 13 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
[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]
==
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]
[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) |
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 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