Article

OBJECTIVE: To derive a clinical decision guide (CDG) to identify patients best
suited for cervical diagnostic facet joint blocks. DESIGN: Prospective cohort
study. SETTING: Pain management center. PARTICIPANTS: Consecutive patients with
neck pain (N=125) referred to an interventional pain management center were
approached to participate. INTERVENTIONS: Subjects underwent a standardized
testing protocol, performed by a physiotherapist, prior to receiving diagnostic
facet joint blocks. All subjects received the reference standard diagnostic facet
joint block protocol, namely controlled medial branch blocks (MBBs). The
physicians performing the MBBs were blinded to the local anesthetic used and
findings of the clinical tests. MAIN OUTCOME MEASURES: Multivariate regression
analyses were performed in the derivation of the CDGs. Sensitivity, specificity,
positive and negative likelihood ratios, and 95% confidence intervals (CIs) were
calculated for the index tests and CDGs. RESULTS: A CDG involving the findings of
the manual spinal examination (MSE), palpation for segmental tenderness (PST),
and extension-rotation (ER) test demonstrated a specificity of 84% (95% CI,
77-90) and a positive likelihood ratio of 4.94 (95% CI, 2.8-8.2). Sensitivity of
the PST and MSE were 94% (95% CI, 90-98) and 92% (95% CI, 88-97), respectively.
Negative findings on the PST were associated with a negative likelihood ratio of
.08 (95% CI, .03-.24). CONCLUSIONS: MSE, PST, and ER may be useful tests in
identifying patients suitable for diagnostic facet joint blocks. Further research
is needed to validate the CDGs prior to their routine use in clinical practice.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS