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"Clinical prediction rules" manual therapy

Emilio J Puentedura, Rebecca Slaughter, Sean Reilly, Erwin Ventura, Daniel Young
STUDY DESIGN: Online survey study. OBJECTIVE: To determine physical therapists' utilization of thrust joint manipulation (TJM) and their comfort level in using TJM between the cervical, thoracic, and lumbar regions of the spine. We hypothesized that physical therapists who use TJM would report regular use and comfort providing it to the thoracic and lumbar spines, but not so much for the cervical spine. BACKGROUND: Recent surveys of first professional physical therapy degree programs have found that TJM to the cervical spine is not taught to the same degree as to the thoracic and lumbar spines...
May 2017: Journal of Manual & Manipulative Therapy
Andrew Bernstetter
PURPOSE: Cervical traction is a commonly utilized intervention in the treatment of patients with neck pain. In 2009, a clinical prediction rule (CPR) was developed as a way to assist clinicians in determining the patient population most likely to respond to cervical traction, though this CPR has yet to be validated. The purpose of this case report is to demonstrate the application of that CPR. CASE DESCRIPTION: The patient was a 46-year-old female with a four-week history of right-sided neck and shoulder pain, with numbness and tingling of her thumb and index finger...
October 2016: Physiotherapy Theory and Practice
César Fernández-de-Las-Peñas, Juan J Fernández-Muñoz, Esperanza Navarro-Pardo, Ricardo F da-Silva-Pocinho, Silvia Ambite-Quesada, Juan A Pareja
OBJECTIVE: Identification of subjects with different sensitization mechanisms can help to identify better therapeutic strategies for carpal tunnel syndrome (CTS). The aim of the current study was to identify subgroups of women with CTS with different levels of sensitization. METHODS: A total of 223 women with CTS were recruited. Self-reported variables included pain intensity, function, disability, and depression. Pressure pain thresholds (PPT) were assessed bilaterally over median, ulnar, and radial nerves, C5-C6 joint, carpal tunnel, and tibialis anterior to assess widespread pressure pain hyperalgesia...
September 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Zachary Walston, Dale Yake
Study Design Case series. Background Low back pain (LBP) is an increasing problem in health care. The evidence for the use of spinal manipulative therapy to treat pediatric patients with LBP is minimal. The treatment of pediatrics with manual therapy, particularly spinal manipulation, is controversial within the medical community, primarily with respect to adverse events. The purpose of this case series was to illustrate the feasibility and safety of lumbar manipulation plus exercise in the adolescent population with mechanical LBP...
May 2016: Journal of Orthopaedic and Sports Physical Therapy
César Fernández-de-Las-Peñas, Joshua A Cleland, Jaime Salom-Moreno, María Palacios-Ceña, Almudena Martínez-Perez, Juan A Pareja, Ricardo Ortega-Santiago
Study Design Secondary analysis of a randomized trial. Background A clinical prediction rule to identify patients with carpal tunnel syndrome (CTS) most likely to respond to manual physical therapy has been published but requires further testing to determine its validity. Objective To assess the validity of a clinical prediction rule proposed for the management of patients with CTS in a different group of patients with a variety of treating clinicians. Methods A preplanned secondary analysis of a randomized controlled trial investigating the efficacy of manual physical therapies, including desensitization maneuvers of the central nervous system, in 120 women suffering from CTS was performed...
June 2016: Journal of Orthopaedic and Sports Physical Therapy
Julie Schwind, Kenneth Learman, Bryan O'Halloran, Christopher Showalter, Chad Cook
BACKGROUND: Minimal clinically important difference (MCID) scores for outcome measures are frequently used evidence-based guides to gage meaningful changes. There are numerous outcome instruments used for analyzing pain, disability, and dysfunction of the low back; perhaps the most common of these is the Oswestry disability index (ODI). A single agreed-upon MCID score for the ODI has yet to be established. What is also unknown is whether selected baseline variables will be universal predictors regardless of the MCID used for a particular outcome measure...
May 2013: Journal of Manual & Manipulative Therapy
Alon Rabin, Anat Shashua, Koby Pizem, Ruthy Dickstein, Gali Dar
STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To determine the validity of a previously suggested clinical prediction rule (CPR) for identifying patients most likely to experience short-term success following lumbar stabilization exercise (LSE). Background Although LSE is commonly used by physical therapists in the management of low back pain, it does not seem to be more effective than other interventions. A 4-item CPR for identifying patients most likely to benefit from LSE has been previously suggested but has yet to be validated...
January 2014: Journal of Orthopaedic and Sports Physical Therapy
A Schäfer, N Gärtner-Tschacher, T Schöttker-Königer
BACKGROUND: In spite of profound advances in the diagnosis and therapy, low back pain (LBP) remains one of the main challenges for health systems in western industrialized countries. Clinical trials and meta-analyses typically show heterogeneous evidence and small effect sizes. One explanation for this phenomenon is the heterogeneous nature of the population of patients with LBP, not adequately considered in clinical practice and research. Recent studies and one meta-analysis show that therapy which is specifically directed at well defined subgroups leads to improved effectiveness of interventions, especially for non-surgical interventions such as manual therapy or physiotherapy...
February 2013: Der Orthopäde
Chad E Cook, Kenneth E Learman, Bryan J O'Halloran, Christopher R Showalter, Vincent J Kabbaz, Adam P Goode, Alexis A Wright
BACKGROUND: Recovery from low back pain (LBP) is multidimensional and requires the use of multiple-response (outcome) measures to fully reflect these many dimensions. Predictive prognostic variables that are present or stable in all or most predictive models that use different outcome measures could be considered "universal" prognostic variables. OBJECTIVE: The aim of this study was to explore the potential of universal prognostic variables in predictive models for 4 different outcome measures in patients with mechanical LBP...
January 2013: Physical Therapy
Kenneth Learman, Christopher Showalter, Chad Cook
Clinical prediction rules (CPR) have been promoted as a natural progression in treatment decision-making. Methodological limitations of derivation and validation studies have resulted in some researchers questioning the indiscriminate use of CPRs. The purpose of this study was to explore the influence of the lumbar spine manipulation CPR (LCPR) use on clinical decision making through a survey of practicing clinicians. A sample of 535 physiotherapists from the United States, who routinely use thrust manipulation (TM), agreed to participate in this study...
December 2012: Manual Therapy
Mark D Bishop, Joel E Bialosky, Josh A Cleland
OBJECTIVES: The purpose of this secondary analysis was 1) to examine patient expectations related to a variety of common interventions for low back pain (LBP) and 2) to determine the influence that specific expectations about spinal manipulation might have had on self-report of disability. METHODS: We collected patients' expectations about the benefit of specific interventions for low back pain. We also collected patients' general expectations about treatment and tested the relationships among the expectation of benefit from an intervention, receiving that intervention and disability-related outcomes...
February 2011: Journal of Manual & Manipulative Therapy
Gail D Deyle, Norman W Gill, Stephen C Allison, Benjamin R Hando, Duneley A Rochino
BACKGROUND: The combination of manual physical therapy and exercise provides important benefit for more than 80% of patients with knee osteoarthritis (OA). Our objective was to determine predictor variables for patients unlikely to respond to these interventions. METHODS: We used a retrospective combined cohort study design to develop a preliminary clinical prediction rule (CPR). To determine useful predictors of nonsuccess, we used an extensive set of 167 baseline variables...
January 2012: Journal of Family Practice
Robert E Boyles, Michael J Walker, Brian A Young, Joseph Strunce, Robert S Wainner
STUDY DESIGN: Secondary analysis of a randomized clinical trial (RCT). OBJECTIVES: To perform a secondary analysis on the treatment arm of a larger RCT to determine differences in treatment outcomes, adverse reactions, and effect sizes between patients who received cervical thrust manipulation and those who received only nonthrust manipulation as part of an impairment-based, multimodal treatment program of manual physical therapy (MPT) and exercise for patients with mechanical neck pain...
March 2010: Journal of Orthopaedic and Sports Physical Therapy
Deepak Sebastian
This case report describes a 57-year-old female who experienced symptoms of scapular pain with pain radiating into the right upper extremity. Initial medical referral suggested, nerve entrapment of a cervical origin. However, the patient did not fit the clinical prediction rule for cervical radiculopathy. Radial nerve bias was positive without cervical provocation, with symptom reproduction at the lateral scapular area. Treatment addressed mechanical dysfunction at the triangular interval formed by the teres major and triceps, comprising manual therapy, neural mobilization, corrective exercise and pain modalities...
February 2010: Physiotherapy Theory and Practice
Joshua A Cleland, Julie M Fritz, Kornelia Kulig, Todd E Davenport, Sarah Eberhart, Jake Magel, John D Childs
STUDY DESIGN: Randomized clinical trial. OBJECTIVE: The purpose of this randomized clinical trial was to examine the generalizability of 3 different manual therapy techniques in a patient population with low back pain that satisfy a clinical prediction rule (CPR). SUMMARY OF BACKGROUND DATA: Recently a CPR that identifies patients with LBP who are likely to respond rapidly and dramatically to thrust manipulation has been developed and validated...
December 1, 2009: Spine
Ian A Young, Lori A Michener, Joshua A Cleland, Arnold J Aguilera, Alison R Snyder
BACKGROUND: To date, optimal strategies for the management of patients with cervical radiculopathy remain elusive. Preliminary evidence suggests that a multimodal treatment program consisting of manual therapy, exercise, and cervical traction may result in positive outcomes for patients with cervical radiculopathy. However, limited evidence exists to support the use of mechanical cervical traction in patients with cervical radiculopathy. OBJECTIVE: The purpose of this study was to examine the effects of manual therapy and exercise, with or without the addition of cervical traction, on pain, function, and disability in patients with cervical radiculopathy...
July 2009: Physical Therapy
Julie M Whitman, Joshua A Cleland, Paul E Mintken, Mike Keirns, Melanie L Bieniek, Stephanie R Albin, Jake Magel, Thomas G McPoil
STUDY DESIGN: Prospective-cohort/predictive-validity study. OBJECTIVES: To develop a clinical prediction rule (CPR) to identify patients who had sustained an inversion ankle sprain who would likely benefit from manual therapy and exercise. BACKGROUND: No studies have investigated the predictive value of items from the clinical examination to identify patients with ankle sprains likely to benefit from manual therapy and general mobility exercises...
March 2009: Journal of Orthopaedic and Sports Physical Therapy
Mark A Waldrop
STUDY DESIGN: Case series. OBJECTIVES: To describe an established method of diagnosing cervical radiculopathy (CR) using a clinical prediction rule (CPR), and to describe the management of 6 patients using intermittent cervical traction (ICT), thoracic thrust joint manipulation (TJM), and exercise. BACKGROUND: Many patients present with unilateral arm pain without having undergone magnetic resonance imaging (MRI) of the cervical spine. Using a CPR has demonstrated high levels of specificity to rule in cervical radiculopathy...
March 2006: Journal of Orthopaedic and Sports Physical Therapy
Joshua A Cleland, Julie M Fritz, John D Childs, Kornelia Kulig
BACKGROUND: Recently a clinical prediction rule (CPR) has been developed and validated that accurately identifies patients with low back pain (LBP) that are likely to benefit from a lumbo-pelvic thrust manipulation. The studies that developed and validated the rule used the identical manipulation procedure. However, recent evidence suggests that different manual therapy techniques may result similar outcomes. The purpose of this study is to investigate the effectiveness of three different manual therapy techniques in a subgroup of patient with low back pain that satisfy the CPR...
February 10, 2006: BMC Musculoskeletal Disorders
Christopher K Li, W Ward Flemons
Many different portable monitors have been used to assess patients with suspected sleep apnea. There is limited evidence for the use of type 2 monitors, especially in the unattended setting in which there may be high rates of data loss. Type 3 monitors have low likelihood ratios for negative tests and can be used to "rule out" sleep apnea. The ability of type 3 monitors to "rule in" sleep apnea is less convincing, but this may improve with the use of improved technology, such as nasal pressure transducers...
June 2003: Clinics in Chest Medicine
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