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)


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


1. Mintken PE, et al. Some Factors Predict Successful Short-Term Outcomes in Individuals With Shoulder Pain Receiving Cervicothoracic Manipulation: A Single-Arm Trial. Phys Ther. 2010; 90(1): 26-42.

2. Mintken PE, et al. Examination of the Validity of a Clinical Prediction Rule to Identify Patients With Shoulder Pain Likely to Benefit From Cervicothoracic Manipulation. J Orthop Sports Phys Ther. 2017; 47(4): 252-260. doi: 10.2519/jospt.2017.7100.

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