Purpose: Identify patients with mechanical neck pain who will demonstrated favorable outcomes following cervical manipulation.

Rule:

Puentedura, et al.:
1. Symptom duration of less than 38 days
2. Positive expectation that manipulation will help
3. Side-to-side difference in cervical rotation ROM of 10° or greater
4. Pain with posteroanterior spring testing of the middle cervical spine

Stage of CPR Development: Derivation.

Variables Sensitivity Specificity +LR Prob of Success
3 0.81 0.94 13.50 90%
4 0.50 1.00 100%

Tseng, et al.:
1. Neck Disability Index < 11.5
2. Bilateral involvement
3. Not performing sedentary work > 5 hours a day
4. Feeling better while moving neck
5. Did not feel worse with cervical extension
6. Diagnosis of spondylosis without radiculopathy

Stage of CPR Development: Derivation.

Variables Sensitivity Specificity +LR Prob of Success
1 0.02 0.75 0.07 10%
2 0.08 0.57 0.20 23%
3 0.43 0.78 1.93 74%
4 0.40 0.93 5.33 89%
5 0.07 1.00 100%

Research:

1. Puentedura EJ, et al. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from thrust joint manipulation to the cervical spine. J Orthop Sports Phys Ther. 2012; 42(7): 577-92.

2. Tseng YL, et al. Predictors for the immediate responders to cervical manipulation in patients with neck pain. Manual Therapy. 2006; 11(4): 306–315.

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