Clinical Prediction Models

This article highlights the clinical findings that suggest spinal manipulation will improve a patient. It’s a good read and reinforces the idea that the individual examination of patients and their subsequent subgrouping improves clinical outcomes. Well worth a read.

A Clinical Prediction Rule for Classifying Patients with Low Back Pain Who Demonstrate Short-Term Improvement With Spinal Manipulation

T, Flynn, 2002


Study Design. A prospective, cohort study of patients with nonradicular low back pain referred to physical therapy.

Objective. Develop a clinical prediction rule for spinal manipulation.

Methods. Patients with nonradicular low back pain, standardized examination,, a standardized spinal manipulation treatment program. Success was determined using percent change in disability scores over three sessions.

Results. n=71articipated. A clinical prediction rule with five variables (symptom duration, fear–avoidance beliefs, lumbar hypomobility, hip internal rotation range of motion, and no symptoms distal to the knee) was identified. The presence of four of five of these variables (positive likelihood ratio = 24.38) increased the probability of success with manipulation from 45% to 95%.

Conclusion. Patients with low  back pain likely to respond to manipulation can be accurately identified before treatment. [Key words: manipulation, classification, low back pain, likelihood ratio, clinical prediction rule]

  • Spine 2002;27:2835–2843