physiotherapy exercises వెన్నెముక నొప్పిలో క్లినికల్ ప్రిడిక్షన్ రూల్/CLINICAL PREDICTION RULES IN SPINAL PAIN

When to use manual therapy techniques in spinal pain?
CLINICAL PREDICTION RULES IN SPINAL PAIN
2. CONTENTS:  Introduction to Clinical prediction rule  What are CPR  Levels of CPR  Types of CPR  Examples  Summary  Reference
3. INTRODUCTION  A trend in manual therapy has been the development of Clinical Prediction Rules (CPR).  CPRs are derived statistically i.e. literally “translated” from research evidence with the aim of identifying the combinations of clinical examination findings that can predict a condition or outcome. (Fritz et al., 2003; Fritz, 2009; Cook, 2008)
4. Clinical prediction rules are decision-making tools that contain predictor variables obtained from patient history, examination, and simple diagnostic tests; they can assist in making a diagnosis, establishing prognosis, or determining appropriate management.
5. WHAT ARE CLINICAL PREDICTION RULES (CPRS)?  Evidence-based medicine  Clinical decision making algorithm  Increase sensitivity and specificity of clinical examination  Decrease use of unnecessary tests  Decrease use of ineffective treatments Glynn & Weisbach
6. How are they developed? 4 LEVELS OF CPRS I: demonstrated effectiveness in a varied population on a large scale II: validated in a broad patient population III: validation of the CPR in a patient sample; confirm predictor variables weren’t due to chance or errors within the study; new patients, new investigators IV: rule has been developed and tested in a specific population; predictor variables are selected Glynn & Weisbach
7. TYPES OF CPRS Diagnostic: Probability that a specific condition exists. Prognostic: Likely outcome for patients with a specific condition. Prescriptive: Determine which patients will likely respond favorably to a specific treatment or combination of treatments. Glynn & Weisbach
8. DIAGNOSTIC CPRS
9. Purpose: Identify signs and symptoms indicative of lumbar spinal stenosis. Rule: 1. Bilateral symptoms 2. Leg pain back pain 3. Pain during walking/standing 4. Pain relief upon sitting 5. 48 years old Diagnosis : Lumbar Spinal Stenosis
10. Purpose: To identify patients with neck and arm pain likely presenting with cervical radiculopathy based on specific patient characteristics. Rule: 1.Positive Upper Limb Tension Test A 2. Involved cervical rotation less than 60 degrees 3. Positive Distraction Test 4. Positive Spurling’s A Diagnosis : Cervical Radiculopathy
11. PROGNOSTIC CPRS
12. RECOVERY WITH LBP
Predictor variables Initial pain 8/10  pain less than 6 days.
No more than 1 previous episode of LBP
All three predictor variables present
Study participants received mobilization therapy 95 better at 12 weeks pain 01/10 for 1 week Hancock et al. (2009)
13. INTERVENTIONAL CPRS
14. Mechanical Traction for Neck Pain Purpose: Identify patients with neck pain likely to improve with cervical traction and exercise. Rule: 1. Patient reported peripheralization with lower cervical spine C4-c7 mobility testing 2. Positive shoulder abduction test 3. Age greater than 55 4. Positive upper limb tension test A 5. Positive neck distraction test Three or more predictor variables indicates a moderate likelihood that traction and exercise will produced a perceived benefit Raney et al.
15. Variables Sensitivity Sensitivity
16. MECHANICAL TRACTION FOR LOW BACK PAIN Purpose: Identify patients with low back pain who likely will respond favorably to mechanical lumbar traction. Rule: 1. FABQ-W score less than 21
2. No neurological deficit involvement 3. Age older than 30 4. Non-manual work job status
17. Variables Sensitivity Specificity
THORACIC MANIPULATION FOR NECK PAIN
Purpose: Identify patients with neck pain who are likely to experience early success from thoracic spine thrust manipulation, exercise, and patient education.
Rule:
1. Symptoms less than 30 days
2. No symptoms distal to the shoulder
3. Looking up does not aggravate symptoms
4. FABQ-PA score 12
5. Diminished upper thoracic spine kyphosis
6. Cervical extension ROM 30 degrees

physiotherapy exercises వెన్నెముక నొప్పిలో క్లినికల్ ప్రిడిక్షన్ రూల్/CLINICAL PREDICTION RULES IN SPINAL PAIN
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