Clinical Prediction Rule (Full Version)

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RoyCoronado -> Clinical Prediction Rule (April 21, 2006 10:32:00 AM)

Hi all,

I am currently a 2nd year MPT student and had a few questions about the clinical prediction rule criteria referenced by Flynn, et al in Spine 2002.

Are these characteristics of a typical patient seen in the clinic?

With this manipulation, I could not find what was being manipulated, is it the L-spine, SI, or is this a general spinal manipulation?

Roy Coronado SPT, CSCS
Student



apolipo -> Re: Clinical Prediction Rule (April 21, 2006 10:51:00 AM)

Roy,

I have seen the study your refer to, as well as a recent f/u study in JOSPT. I could find 4/5 of the criteria in a fair percentage of my pts. The one I am least likely to find is onset within the last 16 days. Many of the pts. I see tell me that their pain began several months or years ago and they "hoped it would just go away".

Yes, the manip is a general spinal manipulation. In fact, if you read the editoral in the April JOSPT by Timothy Flynn, he argues that many of the mobs/manips we use, that are supposed to target specific structures and levels, often are not specific at all.

I must admit, this has been a thought in the back of my head for some time. I am interested to see where Flynn and Childs go from here. It could lead to a shake-up in the world of the mobipulators.

mike t



nari -> Re: Clinical Prediction Rule (April 21, 2006 12:35:00 PM)

I think a shake-up is needed in the world of mobipulation; Flynn and Childs may well do this and with some luck/good management PTs may look back on those funny times when patients came in for a wiggle/waggle/push and pull aimed more or less at a vertebral segment. Then our textbook of techniques may well be a very slim volume indeed, and our patients hopefully will do better in the long run.

Nari



JLS_PT_OCS -> Re: Clinical Prediction Rule (April 21, 2006 3:26:00 PM)

Hi Roy.
Go to the manual therapy section and read "Diagnosis and Palpation in Manual Tx".
It's long, but worth it in terms of education.

We need to shake the strict biomechanical approach out of our profession, and the leaders in the field (such as Flynn and Childs) are the first to admit that manipulation is a much more general treatment than previously thought and that the most likely mechanism for relief with the technique is found not in biomechanics, but in neurophysiology. Stay tuned, and check out the Evidence in Motion site and blog for more details.
J



steve -> Re: Clinical Prediction Rule (April 24, 2006 7:38:00 AM)

Roy,

With respect to these criteria being applicable to patients in the typical outpatient setting, I believe that 30% of LBP patients fit the criteria for the rule in this multicentred trial. I have been using the rule since it was published and have found that the number of patients fitting the rule has steadily increased (Particularly the time since injury), likely as a result of word of mouth from previous successful CPR patients.

Steve



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