Traction for Neck Pain CPR
Original Editor-Miwa Matsumoto
Top Contributors-Miwa Matsumoto,Admin,Evan Thomas,Simisola Ajeyalemi,Kim Jackson,WikiSysopandClaire Knott
Description[edit|edit source]
Raney et al[1]developed a Clinical Prediction Rule (CPR) for identifying patients with neck pain likely to respond to mechanical cervical traction. Eighty patients with neck pain received 6 sessions of intermittent cervical traction and cervical exercises 2x/week for 3 weeks. Outcome was measured based on the global rating of change (>±6 were classified as having a successful outcome). Based on a significance level ofP<0.15, five variables out of 15 potential variables were retained in the final regression model.
A CPR with 5 variables was identified:
- patient reported periperalization with lower cervical spine (C4-7) mobility testing,
- positive shoulder abduction test,
- age>55,
- positive upper limb tension test A,
- positive neck distraction test
Although a following validation study is warranted, this preliminary CPR provides the ability for a clinician to identify the sub-group of patients with neck pain who would most likely to benefit from cervical traction and exercise.
Combination of Predictor Variables and Associated Accuracy Statistics[1][edit|edit source]
The probability of successful outcome after cervical traction is calculated using the + LR and pretest probability of 44% (30 out of 68 patients). Accuracy statistics with 95% CI for individual variables for predicting success with cervical traction.
# of predictors present | Sensitivity | Specificity | + LR | - LR | Probability of success w/ cervical traction + exercise |
>4 | 0.30(0.17-0.48) | 1.0(0.91-1.0) | 23.1(2.25 - -227.90) | 0.71(0.53-0.85) | 94.8% |
>3 | 0.63(0.46-0.78) | 0.87(0.73-0.94) | 4.81(2.17-11.4) | 0.42(0.25-0.65) | 79.2% |
>2 | 0.30(0.17-0.48) | 0.97(0.87-1.00) | 1.44(1.05-2.03) | 0.40(0.16-0.90) | 53.2% |
>1 | 0.07(0.02-0.21) | 0.97(0.87-1.00) | 1.15(0.97-1.4) | 0.21(0.03-1.23) | 47.6% |
- Having at least 3 out of 5 predictors appears to be the optimal threshold for choosing the cervical traction as an intervention.
- 少于2预测可能indicate a sub-group who would preferentially benefit from a different intervention (e.g.) pt had 1/5 predictor variables, the post-test probability of success with cervical traction and exercise is only 47.5%, less than a chance.
Description of Special Tests[1][edit|edit source]
Test | Procedure | Positive Test |
Shoulder abduction test | Pt in sitting position. Pt is instructed to place the hand of the affected extremity on the head in order to support the extremity in the scapular plane | Alleviation of symptoms |
Upper limb tension test (ULTT A) | Pt supine. Examiner sequentially introduces the following movements to the symptomatic UE:
|
Reproduction of symptoms |
Neck distraction test | Pt supine w/ neck comfortably positioned. Examiner securely grasps the pt's head under the occiput and chin and gradually applies an axial traction force up to approximately 30 pounds. | Reduction or elimination of symptoms |
Description of Exercises[1][2][edit|edit source]
Exercise | Procedure |
Seated posture exercise | Pt sitting with spine in a natural lordosis. Pt retract scapulae and gently elongate the cervical spines to achieve a neutral upright postural position. (Hold 10 sec, 2x/hr) |
DNF exercise | Pt supine. Perform a slow and controlled craniocervical flexion motion without contracting the large superficial anterior neck muscles. (Hold 10 sec x 10; 2x/day) |
Recent Related Research (fromPubmed)[edit|edit source]
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References[edit|edit source]
- ↑1.01.11.21.3Raney N, Petersen EJ, Smith TA, Cowan JE, Rendeiro DG, Deyle GD, Childs JD. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J 2009;18:382-391
- ↑Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002;27:1835-1843