Flynn Timothy, Fritz Julie, Whitman Julie, Wainner Robert, Magel Jake, Rendeiro Daniel, Butler Barbara, Garber Matthew, Allison Stephen
U.S. Army-Baylor University Graduate Program in Physical Therapy, San Antonio, Texas, USA.
Spine (Phila Pa 1976). 2002 Dec 15;27(24):2835-43. doi: 10.1097/00007632-200212150-00021.
A prospective, cohort study of patients with nonradicular low back pain referred to physical therapy.
Develop a clinical prediction rule for identifying patients with low back pain who improve with spinal manipulation.
Development of clinical prediction rules for classifying patients with low back pain who are likely to respond to a particular intervention, such as manipulation, would improve clinical decision-making and research.
Patients with nonradicular low back pain underwent a standardized examination and then underwent a standardized spinal manipulation treatment program. Success with treatment was determined using percent change in disability scores over three sessions and served as the reference standard for determining the accuracy of examination variables. Examination variables were first analyzed for univariate accuracy in predicting success and then combined into a multivariate clinical prediction rule.
Seventy-one patients participated. Thirty-two had success with the manipulation intervention. A clinical prediction rule with five variables (symptom duration, fear-avoidance beliefs, lumbar hypomobility, hip internal rotation range of motion, and no symptoms distal to the knee) was identified. The presence of four of five of these variables (positive likelihood ratio = 24.38) increased the probability of success with manipulation from 45% to 95%.
It appears that patients with low back pain likely to respond to manipulation can be accurately identified before treatment.
一项针对转介至物理治疗的非根性下腰痛患者的前瞻性队列研究。
制定一项临床预测规则，以识别经脊柱推拿治疗后病情改善的下腰痛患者。
制定临床预测规则，用于对可能对特定干预措施（如推拿）有反应的下腰痛患者进行分类，将有助于改善临床决策和研究。
非根性下腰痛患者接受标准化检查，然后接受标准化脊柱推拿治疗方案。治疗成功与否通过三个疗程中残疾评分的百分比变化来确定，并作为确定检查变量准确性的参考标准。首先分析检查变量在预测成功方面的单变量准确性，然后将其组合成多变量临床预测规则。
71名患者参与研究。32名患者推拿干预成功。确定了一个包含五个变量（症状持续时间、恐惧回避信念、腰椎活动度降低、髋关节内旋活动范围以及膝部以下无症状）的临床预测规则。这五个变量中出现四个（阳性似然比=24.38）可将推拿成功的概率从45%提高到95%。
似乎在治疗前就能准确识别出可能对推拿有反应的下腰痛患者。
