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)
Rule:
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 |
| 3+ | 5.49 | 86.0% |
| 4+ | 12.00 | 93.0% |
| 5+ | ∞ | 100.0% |
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 |
Continued Learning…
Continued Reading…
John Snyder, DPT 
It should be pointed out that this particular CPR was found to be NOT VALID… The second reference details how the rule did not help determine which subjects would do better with thoracic manipulation. Instead, ALL subjects who got thoracic manipulation did better. This had led to the belief that all subjects with neck pain who do not have any contraindications to thoracic manipulation should receive it…. The leafy green vegetable analogy…
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Louie,
Thanks for your comment! The next phase of this resource is to include level of evidence and validation/invalidation as the evidence currently stands. The specific emphasis will be on those CPRs that have failed to hold up under further investigation (i.e. stabilization for LBP, lumbopelvic manipulation for PFPS, ect.).
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