Purpose: Identify individuals with shoulder pain who are likely to experience immediate improvement in pain and disability following cervical and thoracic spine manipulation.
Stage of CPR Development: Invalidated (Mintken et al., 2017)
Rule:
1. Pain-free shoulder flexion < 127°
2. Shoulder internal rotation < 53° at 90° of abduction
3. Negative Neer test
4. Not taking medications for their shoulder pain
5. Symptoms less than 90 days
Derivation Study (Mintken et al., 2010):
| Variables | Sensitivity | Specificity | +LR | Prob of Success |
| 2 | 0.90 | 0.61 | 2.30 | 78% |
| 3 | 0.51 | 0.90 | 5.30 | 89% |
| 4 | 0.27 | 1.00 | ∞ | 100% |
Validation Study (Mintken et al., 2017):
| Analysis | p-value |
| Linear Mixed-Model with Repeated Measures | 0.094 |
| Positive on Rule MT+Ex v. Ex Only (SPADI) | 0.69 |
| 3-way Interaction (SPADI) | 0.27 |
| 3-way Interaction (Pain Score) | 0.70 |
| Repeated Measures Analyses (SPADI) | 0.62 |
| Repeated Measures Analyses (Pain Score) | 0.87 |
Continued Learning…
Continued Reading…
John Snyder, DPT 
Shoulder pain is becoming a concern these days. A person who is experiencing always wishes to get rid of the pain and we thankfully have great remedies for the same. Thank you for sharing the post.
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With the rapid competition in any field, there are hardly few people who are lucky enough not to have back pain and shoulder pain. Helpful information. Thanks for the post.
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Thoracic manual therapy (TMT) may utilise similar neurophysiological effects with less risk.
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Nice postt thanks for sharing
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