Independent evaluation of a clinical prediction rule for spinal manipulative therapy: a randomised controlled trial
Open Access
- 22 April 2008
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Spine Journal
- Vol. 17 (7), 936-943
- https://doi.org/10.1007/s00586-008-0679-9
Abstract
A clinical prediction rule to identify patients most likely to respond to spinal manipulation has been published and widely cited but requires further testing for external validity. We performed a pre-planned secondary analysis of a randomised controlled trial investigating the efficacy of spinal manipulative therapy in 239 patients presenting to general practice clinics for acute, non-specific, low back pain. Patients were randomised to receive spinal manipulative therapy or placebo 2 to 3 times per week for up to 4 weeks. All patients received general practitioner care (advice and paracetamol). Outcomes were pain and disability measured at 1, 2, 4 and 12 weeks. Status on the clinical prediction rule was measured at baseline. The clinical prediction rule performed no better than chance in identifying patients with acute, non-specific low back pain most likely to respond to spinal manipulative therapy (pain P = 0.805, disability P = 0.600). At 1-week follow-up, the mean difference in effect of spinal manipulative therapy compared to placebo in patients who were rule positive rather than rule negative was 0.3 points less on a 10-point pain scale (95% CI −0.8 to 1.4). The clinical prediction rule proposed by Childs et al. did not generalise to patients presenting to primary care with acute low back pain who received a course of spinal manipulative therapy.Keywords
This publication has 26 references indexed in Scilit:
- Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trialPublished by Elsevier BV ,2007
- Early Intervention for the Management of Acute Low Back PainSpine, 2004
- Do Primary-Care Clinicians Think That Nonspecific Low Back Pain Is One Condition?Spine, 2004
- Subgroup analyses in randomized trials: risks of subgroup-specific analyses;Journal of Clinical Epidemiology, 2004
- Spinal manipulative therapy for low-back painPublished by Wiley ,2004
- Comparison of Classification-Based Physical Therapy With Therapy Based on Clinical Practice Guidelines for Patients with Acute Low Back PainSpine, 2003
- A Clinical Prediction Rule for Classifying Patients with Low Back Pain Who Demonstrate Short-Term Improvement With Spinal ManipulationSpine, 2002
- Clinical Guidelines for the Management of Low Back Pain in Primary CareSpine, 2001
- Subgroup analyses in randomised controlled trials: quantifying the risks of false-positives and false-negativesHealth Technology Assessment, 2001
- Users' Guides to the Medical LiteraturePublished by American Medical Association (AMA) ,2000