Childs, John David
(2003)
Validation of A Clinical Prediction Rule to Identify Patients Likely to Benefit from Spinal Manipulation: A Randomized Clinical Trial.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Purpose: The primary aim of this study was to validate a clinical prediction rule (CPR) to identify patients with low back pain (LBP) likely to benefit from spinal manipulation. Subjects: 131 consecutive patients referred for physical therapy. Patients with positive neurologic signs or other red flags for spinal manipulation were excluded. Method: A multicenter, randomized clinical trial. After completing a standardized history and physical examination, patients were randomly assigned to receive spinal manipulation (n=70) or a stabilization exercise intervention (n=61). Patients were seen in physical therapy twice the first week, then once a week for the next three weeks, for a total of five sessions. A single manipulative intervention was used for patients who received spinal manipulation during each of the first two sessions, who then completed the stabilization exercise intervention for the remaining three weeks. Patients who achieved at least a 50% improvement in their Oswestry Disability Questionnaire (ODQ) score were classified as a success. Patients who met at least 4/5 criteria in the CPR were classified as positive. Analyses: A 2*2*3 repeated measures multivariate analysis of variance (MANOVA) was performed, followed by a Bonferroni procedure for planned comparisons. Sensitivity, specificity, and positive and negative likelihood ratios (LR) with associated 95% confidence intervals were calculated. Results: There was a significant three-way CPR*Intervention*Time interaction for the overall repeated measures MANOVA (p<.001). Patients classified as positive on the CPR and received spinal manipulation achieved 2.5 times the minimum clinically important difference (MCID) on the ODQ compared to patients classified as negative on the CPR and received spinal manipulation and 3.4 times the MCID compared to patients classified as positive on the CPR but received the stabilization exercise intervention (p<.001). These results were maintained at the four-week follow-up (p<.003). With a positive LR of 13.2 (3.4, 52.1) and based on a pre-test probability of success of 44.3%, this translates into a post-test probability of success of 91.2%. Conclusions: The results of this study support the validity of the spinal manipulation CPR. Clinical Relevance: Clinicians can accurately identify patients with LBP likely to benefit from spinal manipulation.
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| Item Type: |
University of Pittsburgh ETD
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| Status: |
Unpublished |
| Creators/Authors: |
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| ETD Committee: |
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| Date: |
4 September 2003 |
| Date Type: |
Completion |
| Defense Date: |
24 June 2003 |
| Approval Date: |
4 September 2003 |
| Submission Date: |
22 August 2003 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Health and Rehabilitation Sciences > Rehabilitation Science |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
accuracy; algorithms; classification; clinical prediction rule; decision rules; evidence-based practice; fear-avoidance beliefs; lumbopelvic; mobilization; prediction; risk; sacroiliac joint |
| Other ID: |
http://etd.library.pitt.edu:80/ETD/available/etd-08222003-013408/, etd-08222003-013408 |
| Date Deposited: |
10 Nov 2011 20:00 |
| Last Modified: |
15 Nov 2016 13:49 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/9230 |
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