In the previous post, we discussed a clinical prediction rule for patients presenting with neck pain who would benefit from thoracic manipulation.
We would like to clarify that the CPR only provides the ability to a priori identify individuals who would likely have early success after being treated with thoracic spine manipulation. A priori is defined as reasoning that proceeds from theoretical deduction rather than experience or observation. Cleland et al stated in their original article that further studies needed to be performed in order to validate this CPR.
A follow-up study found that this CPR did not prove valid. However, Cleland et al did point out that while the CPR lost validity, patients with mechanical neck pain who were treated with thoracic spine manipulation had significantly greater improvements in short and long term disability (based off the Neck Disability Index). Additionally, these individuals had less pain at 1-week follow up compared with individuals who only received exercise.
In conclusion, the CPR for patients presenting with neck pain who would benefit from thoracic manipulation was not validated. As clinicians, still be cognizant that thoracic manipulation can improve your patient's neck pain and disability status. While the 6 predictive variables of the CPR cannot be used in isolation, the importance of these factors should still be documented to help guide your differential diagnosis.
A quick thank you to Steve who brought this information to our attention!
Neck Disability Index criteria for scoring can be found HERE.
Clinical Prediction Rule for Thoracic Manipulation for Patients Presenting with Neck Pain
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