Article

A clinical prediction rule (CPR) purported to identify patients with
neck pain who are likely to respond to thoracic spine thrust manipulation has
recently been developed,
but has yet to be validated.
The purpose of
this study was to examine the validity of this CPR.
DESIGN: This was a
multi-center randomized clinical trial. METHODS: One hundred forty patients with
a primary report of neck pain were randomly assigned to receive either 5 sessions
of stretching and strengthening exercise (exercise-only group) or 2 sessions of
thoracic spine manipulation and cervical range of motion exercise followed by 3
sessions of stretching and strengthening exercise (manipulation + exercise
group). Data on disability and pain were collected at baseline, 1 week, 4 weeks,
and 6 months. The primary aim (treatment group x time x status on the prediction
rule) was examined using a linear mixed model with repeated measures. Time,
treatment group, and status on the rule, as well as all possible 2-way and 3-way
interactions, were modeled as fixed effects, with disability (and pain) as the
dependent variable. Effect sizes were calculated for both pain and disability at
each follow-up period. RESULTS: There was no 3-way interaction for either
disability or pain. A 2-way (group x time) interaction existed for both
disability and pain. Pair-wise comparisons of disability demonstrated that
significant differences existed at each follow-up period between the manipulation
+ exercise group and the exercise-only group. The patients who received
manipulation exhibited lower pain scores at the 1-week follow-up period. The
effect sizes were moderate for disability at each follow-up period and were
moderate for pain at the 1-week follow-up. LIMITATIONS:Different exercise
approaches may have resulted in a different outcome. CONCLUSIONS: The results of
the current study did not support the validity of the previously developed CPR.
However, the results demonstrated that patients with mechanical neck pain who
received thoracic spine manipulation and exercise exhibited significantly greater
improvements in disability at both the short- and long-term follow-up periods and
in pain at the 1-week follow-up compared with patients who received exercise only.

Langue : ANGLAIS