Clinical Prediction Rules: Lumbar Manipulation

Do you ever wonder treatments will give your patient the best results? With the help of clinical prediction rules, we have the opportunity to utilize validated research studies to help with the diagnosis and treatment of individuals with a variety of different “tissue issues.” The next several posts will include various clinical prediction rules and the articles/abstracts associated with the research.

In 2004, Childs et al published the study, “A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study.” This study aimed to confirm what Flynn et al found in 2002 , which was a clinical prediction rule involving a high-velocity, low amplitude thrust technique directed at the lumbar spine. The five clinical predictors are the following:

  • Onset of symptoms less than 16 days.
  • No symptoms distal to the knee.
  • FABQ score less than 19.
  • Passive hip internal rotation greater than 35 degrees.
  • Hypomobility with PA spring testing in the lumbar spine.

The study found a 92% success rate for those who were positive on at least 4 out of the 5 clinical predictors.

An additional study by Fritz et al found that of the five clinical predictors, the most important predictors were the following:

  • No symptoms distal to the knee
  • Symptoms less than 16 days

If your patient is positive on this modified rule, the post-test chance of success is nearly 88%.

So what does this mean? If you are thorough with your clinical examination, you may be able to better treat your patients by applying these clinical predictors into your physical therapy plan of care.


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