Purpose: Identify patients with neck pain who are likely to experience early success from thoracic spine thrust manipulation, exercise, and patient education.
Stage of CPR Development: Invalidated (Cleland et al., 2010)
1. Symptoms < 30 days
2. No symptoms distal to the shoulder
3. Looking up does not aggravate symptoms
4. FABQ-PA score < 12
5. Diminished upper thoracic spine kyphosis
6. Cervical extension ROM < 30 degrees
Derivation Study (Cleland et al., 2007):
|Variables||+LR||Prob of Success|
Validation Study (Cleland et al., 2010):
|Group||Disability (p-Value)||Pain Score (p-Value)|
|One Week||Manipulation + Exercise vs Exercise Only||0.003||< 0.001|
|+CPR vs -CPR||0.07||0.18|
|Manipulation X Status on Rule||0.011||0.014|
|Four Weeks||Manipulation + Exercise vs Exercise Only||0.001||0.29|
|+CPR vs -CPR||0.05||0.63|
|Manipulation X Status on Rule||0.012||0.74|
|Six Months||Manipulation + Exercise vs Exercise Only||< 0.001||0.08|
|+CPR vs -CPR||0.09||0.64|
|Manipulation X Status on Rule||0.35||0.61|
1. Cleland JA, et al. Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation, exercise, and patient education. Phys Ther. 2007; 87(1): 9-23.
2. Cleland JA, et al. Examination of a Clinical Prediction Rule to Identify Patients With Neck Pain Likely to Benefit From Thoracic Spine Thrust Manipulation and a General Cervical Range of Motion Exercise: Multi-Center Randomized Clinical Trial. Phys Ther. 2010; 90(9): 1239-1250.