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John D Childs - One of the best experts on this subject based on the ideXlab platform.

  • derivation of a preliminary Clinical Prediction Rule for identifying a subgroup of patients with low back pain likely to benefit from pilates based exercise
    Journal of Orthopaedic & Sports Physical Therapy, 2012
    Co-Authors: Lise R Stolze, Stephen Allison, John D Childs
    Abstract:

    Study Design Prospective cohort study. Objective To derive a preliminary Clinical Prediction Rule for identifying a subgroup of patients with low back pain (LBP) likely to benefit from Pilates-based exercise. Background Pilates-based exercise has been shown to be effective for patients with LBP. However, no previous work has characterized patient attributes for those most likely to have a successful outcome from treatment. Methods Ninety-six individuals with nonspecific LBP participated in the study. Treatment response was categorized based on changes in the Oswestry Disability Questionnaire scores after 8 weeks. An improvement of 50% or greater was categorized as achieving a successful outcome. Thirty-seven variables measured at baseline were analyzed with univariate and multivariate methods to derive a Clinical Prediction Rule for successful outcome with Pilates exercise. Accuracy statistics, receiver-operator curves, and regression analyses were used to determine the association between standardized ex...

  • 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
    Physical Therapy, 2010
    Co-Authors: Joshua A Cleland, Julie M Fritz, Julie M Whitman, Paul E Mintken, Kristin J Carpenter, Paul Glynn, John D Childs
    Abstract:

    Background. A Clinical Prediction Rule (CPR) purported to identify patients with neck pain who are likely to respond to thoracic spine thrust manipulation has recently been developed, but has yet to be validated. Objective. The purpose of this study was to examine the validity of this CPR. Design. This was a multi-center randomized Clinical trial. Methods. One hundred forty patients with a primary report of neck pain were randomly assigned to receive either 5 sessions of stretching and strengthening exercise (exercise-only group) or 2 sessions of thoracic spine manipulation and cervical range of motion exercise followed by 3 sessions of stretching and strengthening exercise (manipulation exercise group). Data on disability and pain were collected at baseline, 1 week, 4 weeks, and 6 months. The primary aim (treatment group time status on the Prediction Rule) was examined using a linear mixed model with repeated measures. Time, treatment group, and status on the Rule, as well as all possible 2-way and 3-way interactions, were modeled as fixed effects, with disability (and pain) as the dependent variable. Effect sizes were calculated for both pain and disability at each follow-up period. Results. There was no 3-way interaction for either disability or pain. A 2-way (group time) interaction existed for both disability and pain. Pair-wise comparisons of disability demonstrated that significant differences existed at each follow-up period between the manipulation exercise group and the exercise-only group. The patients who received manipulation exhibited lower pain scores at the 1-week follow-up period. The effect sizes were moderate for disability at each follow-up period and were moderate for pain at the 1-week follow-up. Limitations. Different exercise approaches may have resulted in a different outcome. Conclusions. The results of the current study did not support the validity of the previously developed CPR. However, the results demonstrated that patients with mechanical neck pain who received thoracic spine manipulation and exercise exhibited significantly greater improvements in disability at both the short- and longterm follow-up periods and in pain at the 1-week follow-up compared with patients who received exercise only.

  • comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a Clinical Prediction Rule a randomized Clinical trial
    Spine, 2009
    Co-Authors: Joshua A Cleland, Julie M Fritz, Jake Magel, Kornelia Kulig, Todd E Davenport, Sarah Eberhart, John D Childs
    Abstract:

    STUDY DESIGN: Randomized Clinical trial. OBJECTIVE: The purpose of this randomized Clinical trial was to examine the generalizability of 3 different manual therapy techniques in a patient population with low back pain that satisfy a Clinical Prediction Rule (CPR). SUMMARY OF BACKGROUND DATA: Recently a CPR that identifies patients with LBP who are likely to respond rapidly and dramatically to thrust manipulation has been developed and validated. The generalizability of the CPR requires further investigation. METHODS: A total of 112 patients were enrolled in the trial and provided demographic information and completed a number of self-report questionnaires including the Oswestry Disability Questionnaire (ODQ) and the Numerical Pain Rating Scale (NPRS) at baseline, 1-week, 4-weeks, and 6-months. Patients were randomly assigned to receive 1 of the 3 manual therapy techniques for 2 consecutive treatment sessions followed by exercise regimen for an additional 3 sessions. We examined the primary aim using a linear mixed model for repeated measures, using the ODQ and NPRS as dependent variables. The hypothesis of interest was the group by time interaction, which was further explored with pair-wise comparisons of the estimated marginal means. RESULTS: There was a significant group x time interaction for the ODQ (P < 0.001) and NPRS scores (P = 0.001). Pair-wise comparisons revealed no differences between the supine thrust manipulation and side-lying thrust manipulation at any follow-up period. Significant differences in the ODQ and NPRS existed at each follow-up between the thrust manipulation and the nonthrust manipulation groups at 1-week and 4-weeks. There was also a significant difference in ODQ scores at 6-months in favor of the thrust groups. CONCLUSION: The results of the study support the generalizability of the CPR to another thrust manipulation technique, but not to the nonthrust manipulation technique that was used in this study. In general, our results also provided support that the CPR can be generalized to different settings from which it was derived and validated. However, additional research is needed to examine this issue.

  • comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a Clinical Prediction Rule a randomized Clinical trial
    Spine, 2009
    Co-Authors: Joshua A Cleland, Julie M Fritz, Jake Magel, Sarah L Eberhart, Kornelia Kulig, Todd E Davenport, John D Childs
    Abstract:

    STUDY DESIGN: Randomized Clinical trial. OBJECTIVE: The purpose of this randomized Clinical trial was to examine the generalizability of 3 different manual therapy techniques in a patient population with low back pain that satisfy a Clinical Prediction Rule (CPR). SUMMARY OF BACKGROUND DATA: Recently a CPR that identifies patients with LBP who are likely to respond rapidly and dramatically to thrust manipulation has been developed and validated. The generalizability of the CPR requires further investigation. METHODS: A total of 112 patients were enrolled in the trial and provided demographic information and completed a number of self-report questionnaires including the Oswestry Disability Questionnaire (ODQ) and the Numerical Pain Rating Scale (NPRS) at baseline, 1-week, 4-weeks, and 6-months. Patients were randomly assigned to receive 1 of the 3 manual therapy techniques for 2 consecutive treatment sessions followed by exercise regimen for an additional 3 sessions. We examined the primary aim using a linear mixed model for repeated measures, using the ODQ and NPRS as dependent variables. The hypothesis of interest was the group by time interaction, which was further explored with pair-wise comparisons of the estimated marginal means. RESULTS: There was a significant group x time interaction for the ODQ (P < 0.001) and NPRS scores (P = 0.001). Pair-wise comparisons revealed no differences between the supine thrust manipulation and side-lying thrust manipulation at any follow-up period. Significant differences in the ODQ and NPRS existed at each follow-up between the thrust manipulation and the nonthrust manipulation groups at 1-week and 4-weeks. There was also a significant difference in ODQ scores at 6-months in favor of the thrust groups. CONCLUSION: The results of the study support the generalizability of the CPR to another thrust manipulation technique, but not to the nonthrust manipulation technique that was used in this study. In general, our results also provided support that the CPR can be generalized to different settings from which it was derived and validated. However, additional research is needed to examine this issue.

  • development of a Clinical Prediction Rule to identify patients with neck pain likely to benefit from cervical traction and exercise
    European Spine Journal, 2009
    Co-Authors: Nicole H Raney, Evan J Petersen, Tracy A Smith, James E Cowan, Daniel G Rendeiro, Gail D Deyle, John D Childs
    Abstract:

    The objective of the study was to develop a Clinical Prediction Rule (CPR) to identify patients with neck pain likely to improve with cervical traction. The study design included prospective cohort of patients with neck pain referred to physical therapy. Development of a CPR will assist clinicians in classifying patients with neck pain likely to benefit from cervical traction. Eighty patients with neck pain received a standardized examination and then completed six sessions of intermittent cervical traction and cervical strengthening exercises twice weekly for 3 weeks. Patient outcome was classified at the end of treatment, based on perceived recovery according to the global rating of change. Patients who achieved a change ≥+6 (“A great deal better” or “A very great deal better”) were classified as having a successful outcome. Univariate analyses (t tests and chi-square) were conducted on historical and physical examination items to determine potential predictors of successful outcome. Variables with a significance level of P ≤ 0.15 were retained as potential Prediction variables. Sensitivity, specificity and positive and negative likelihood ratios (LRs) were then calculated for all variables with a significant relationship with the reference criterion of successful outcome. Potential predictor variables were entered into a step-wise logistic regression model to determine the most accurate set of Clinical examination items for Prediction of treatment success. Sixty-eight patients (38 female) were included in data analysis of which 30 had a successful outcome. A CPR with five variables was identified: (1) patient reported peripheralization with lower cervical spine (C4–7) mobility testing; (2) positive shoulder abduction test; (3) age ≥55; (4) positive upper limb tension test A; and (5) positive neck distraction test. Having at least three out of five predictors present resulted in a +LR equal to 4.81 (95% CI = 2.17–11.4), increasing the likelihood of success with cervical traction from 44 to 79.2%. If at least four out of five variables were present, the +LR was equal to 23.1 (2.5–227.9), increasing the post-test probability of having improvement with cervical traction to 94.8%. This preliminary CPR provides the ability to a priori identify patients with neck pain likely to experience a dramatic response with cervical traction and exercise. Before the Rule can be implemented in routine Clinical practice, future studies are necessary to validate the Rule. The CPR developed in this study may improve Clinical decision-making by assisting clinicians in identifying patients with neck pain likely to benefit from cervical traction and exercise.

Joshua A Cleland - One of the best experts on this subject based on the ideXlab platform.

  • predictors of chronic prescription opioid use after orthopedic surgery derivation of a Clinical Prediction Rule
    Perioperative medicine (London England), 2018
    Co-Authors: Joshua A Cleland, Daniel I Rhon, Suzanne J Snodgrass, Charles D Sissel, Chad Cook
    Abstract:

    Prescription opioid use at high doses or over extended periods of time is associated with adverse outcomes, including dependency and abuse. The aim of this study was to identify mediating variables that predict chronic opioid use, defined as three or more prescriptions after orthopedic surgery. Individuals were ages between 18 and 50 years and undergoing arthroscopic hip surgery between 2004 and 2013. Two categories of chronic opioid use were calculated based on individuals (1) having three or more unique opioid prescriptions within 2 years and (2) still receiving opioid prescriptions > 1 year after surgery. Univariate elationships were identified for each predictor variable, then significant variables (P > 0.15) were entered into a multivariate logistic regression model to identify the most parsimonious group of predictor variables for each chronic opioid use classification. Likelihood ratios were derived from the most robust groups of variables. There were 1642 participants (mean age 32.5 years, SD 8.2, 54.1% male). Nine predictor variables met the criteria after bivariate analysis for potential inclusion in each multivariate model. Eight variables: socioeconomic status (from enlisted rank family), prior use of opioid medication, prior use of non-opioid pain medication, high health-seeking behavior before surgery, a preoperative diagnosis of insomnia, mental health disorder, or substance abuse were all predictive of chronic opioid use in the final model (seven variables for three or more opioid prescriptions; four variables for opioid use still at 1 year; all< 0.05). Post-test probability of having three or more opioid prescriptions was 93.7% if five of seven variables were present, and the probability of still using opioids after 1 year was 69.6% if three of four variables were present. A combination of variables significantly predicted chronic opioid use in this cohort. Most of these variables were mediators, indicating that modifying them may be feasible, and the potential focus of interventions to decrease the risk of chronic opioid use, or at minimum better inform opioid prescribing decisions. This Clinical Prediction Rule needs further validation.

  • development of a preliminary Clinical Prediction Rule to identify patients with neck pain that may benefit from a standardized program of stretching and muscle performance exercise a prospective cohort study
    The International journal of sports physical therapy, 2013
    Co-Authors: William J Hanney, Morey J Kolber, Steven Z George, Ian Young, Chetan K Patel, Joshua A Cleland
    Abstract:

    BACKGROUND AND PURPOSE Neck pain is a significant problem and many treatment options exist. While some studies suggest exercise is beneficial for individuals with non-specific neck pain clinicians have few tools to assist in the decision making process. Therefore, the purpose of this study was to derive a preliminary Clinical Prediction Rule (CPR) for identifying patients with neck pain (NP) who may respond to an exercise-based treatment program. Exercise-based interventions have demonstrated positive outcomes in patients with NP, however it is unclear which patients are more likely to respond to this treatment approach. METHODS Consecutive patients with a primary report of nonspecific NP with or without arm pain were recruited. All patients participated in a standardized exercise program and then were classified as having a successful or non-successful outcome at 6 weeks. Potential predictor variables were entered into a stepwise regression analysis. Variables retained in the regression model were used to develop a multivariate CPR that can be used to classify patients with NP that may benefit from exercise-based treatment. A 6-month follow up of the patients was used to evaluate the long-term effects. RESULTS Ninety-one patients were enrolled in the study of which 50 had a successful outcome. A CPR with 5 variables was identified (Neck Disability Index score < 18/50, presence of shoulder protraction during static postural assessment, patient does not bicycle for exercise, cervical side bending < 32°, and Fear Avoidance Belief Questionnaire-Physical Activity Score < 15). If 4 of the 5 variables were present, the probability of a successful outcome shifted from 56% to 78% (+LR 2.97). At 6 months no significant difference existed in self-reported outcomes between those considered positive on the Rule for a successful outcome and those negative on the Rule for a successful outcome. CONCLUSIONS The proposed CPR may identify patients with NP likely to benefit from exercise-based treatment in the short term. However, long-term follow up did not demonstrate a significant difference between groups. LEVEL OF EVIDENCE 2b.

  • development of a Clinical Prediction Rule to identify patients with neck pain likely to benefit from thrust joint manipulation to the cervical spine
    Journal of Orthopaedic & Sports Physical Therapy, 2012
    Co-Authors: Emilio J Puentedura, Joshua A Cleland, Merrill R Landers, Paul E Mintken, Adriaan Louw, Cesar Fernandezdelaspenas
    Abstract:

    Study Design Prospective cohort/predictive validity study. Objective To determine the predictive validity of selected Clinical examination items and to develop a Clinical Prediction Rule to determine which patients with neck pain may benefit from cervical thrust joint manipulation (TJM) and exercise. Background TJM to the cervical spine has been shown to be effective in patients presenting with a primary report of neck pain. It would be useful for clinicians to have a decision-making tool, such as a Clinical Prediction Rule, that could accurately identify which subgroup of patients would respond positively to cervical TJM. Methods Consecutive patients who presented to physical therapy with a primary complaint of neck pain completed a series of self-report measures, then received a detailed standardized history and physical examination. After the Clinical examination, all patients received a standardized treatment regimen consisting of cervical TJM and range-of-motion exercise. Depending on response to tre...

  • development of a Clinical Prediction Rule for identifying women with tension type headache who are likely to achieve short term success with joint mobilization and muscle trigger point therapy
    Headache, 2011
    Co-Authors: Cesar Fernandezdelaspenas, Joshua A Cleland, Luis Palomequedelcerro, A B Caminero, A Guillemmesado, Rodrigo Jimenezgarcia
    Abstract:

    (Headache 2011;51:246-261) Objective.— To identify prognostic factors from the history and physical examination in women with tension-type headache (TTH) who are likely to experience self-perceived Clinical improvement following a multimodal physical therapy session including joint mobilization and muscle trigger point (TrP) therapies. Background.— No definitive therapeutic intervention is available for TTH. It would be useful for clinicians to have a Clinical Prediction Rule for selecting which TTH patients may experience improved outcomes following a multimodal physical therapy program. Methods.— Women diagnosed with pure TTH by 3 experienced neurologists according to the International Headache Society criteria from different neurology departments were included. They underwent a standardized examination (neck mobility, pressure pain thresholds, total tenderness score, presence of muscle TrPs, Medical Outcomes Study 36-Item Short Form, the Neck Disability Index [NDI], the Beck Depression Inventory, and the Headache Disability Inventory) and then a multimodal physical therapy session including joint mobilization and TrP therapies. The treatment session included a 30-second grade III or IV central posterior-anterior nonthrust mobilization applied from T4 to T1 thoracic vertebrae, at C7-T1 cervico-thoracic junction and C1-C2 vertebrae for an overall intervention time of 5 minutes Different TrP techniques, particularly soft tissue stroke, pressure release, or muscle energy were applied to head and neck–shoulder muscles (temporalis, suboccipital, upper trapezius, splenius capitis, semispinalis capitis, sternocleidomastoid) to inactivate active muscle TrPs. Participants were classified as having achieved a successful outcome 1 week after the session based on their self-perceived recovery. Potential prognostic variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for Prediction of success. Results.— Data for 76 subjects were included in the analysis, of which 36 experienced a successful outcome (48%). Eight prognostic variables were retained in the regression model: mean age  69°, total tenderness score 42.23. Conclusions.— The current Clinical Prediction Rule may allow clinicians to make an a priori identification of women with TTH who are likely to experience short-term self-report improvement with a multimodal session including joint mobilizations and TrP therapies. Future studies are necessary to validate these findings.

  • a Clinical Prediction Rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses a preliminary determination
    British Journal of Sports Medicine, 2010
    Co-Authors: Bill Vicenzino, Natalie J. Collins, Joshua A Cleland, Thomas G Mcpoil
    Abstract:

    Objective To develop a Clinical Prediction Rule to identify patients with patellofemoral pain (PFP) who are more likely to benefit from foot orthoses. Design Posthoc analysis of one treatment arm of a randomised Clinical trial. Setting Single-centre trial in a community setting in Brisbane, Australia. Participants 42 participants (mean age 27.9 years) with a Clinical diagnosis of PFP (median duration 36 months). Interventions Foot orthoses fitted by a physiotherapist. Main Outcome Measures Five-point global improvement scale at 12-week follow-up, dichotomised with marked improvement equalling success. Results Potential predictor variables identified by univariate analyses were age, height, pain severity, anterior knee pain scale score, functional index questionnaire score, foot morphometry (arch height ratio, mid-foot width difference from non-weight bearing to weight bearing) and overall orthoses comfort. Parsimonious fitting of these variables to a model that explained success with orthoses identified the following: age (>25 years), height ( 10.96 mm). The pretest success rate of 40% increased to 86% if the patient exhibited three of these variables (positive likelihood ratio 8.8; 95% CI 1.2 to 66.9). Conclusion Post-hoc analysis identified age, height, pain severity and mid-foot morphometry as possible predictors of successful treatment of PFP with foot orthoses, thereby providing practitioners with information for prescribing foot orthoses in PFP and stimulating further research.

Julie M Fritz - One of the best experts on this subject based on the ideXlab platform.

  • 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
    Physical Therapy, 2010
    Co-Authors: Joshua A Cleland, Julie M Fritz, Julie M Whitman, Paul E Mintken, Kristin J Carpenter, Paul Glynn, John D Childs
    Abstract:

    Background. A Clinical Prediction Rule (CPR) purported to identify patients with neck pain who are likely to respond to thoracic spine thrust manipulation has recently been developed, but has yet to be validated. Objective. The purpose of this study was to examine the validity of this CPR. Design. This was a multi-center randomized Clinical trial. Methods. One hundred forty patients with a primary report of neck pain were randomly assigned to receive either 5 sessions of stretching and strengthening exercise (exercise-only group) or 2 sessions of thoracic spine manipulation and cervical range of motion exercise followed by 3 sessions of stretching and strengthening exercise (manipulation exercise group). Data on disability and pain were collected at baseline, 1 week, 4 weeks, and 6 months. The primary aim (treatment group time status on the Prediction Rule) was examined using a linear mixed model with repeated measures. Time, treatment group, and status on the Rule, as well as all possible 2-way and 3-way interactions, were modeled as fixed effects, with disability (and pain) as the dependent variable. Effect sizes were calculated for both pain and disability at each follow-up period. Results. There was no 3-way interaction for either disability or pain. A 2-way (group time) interaction existed for both disability and pain. Pair-wise comparisons of disability demonstrated that significant differences existed at each follow-up period between the manipulation exercise group and the exercise-only group. The patients who received manipulation exhibited lower pain scores at the 1-week follow-up period. The effect sizes were moderate for disability at each follow-up period and were moderate for pain at the 1-week follow-up. Limitations. Different exercise approaches may have resulted in a different outcome. Conclusions. The results of the current study did not support the validity of the previously developed CPR. However, the results demonstrated that patients with mechanical neck pain who received thoracic spine manipulation and exercise exhibited significantly greater improvements in disability at both the short- and longterm follow-up periods and in pain at the 1-week follow-up compared with patients who received exercise only.

  • comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a Clinical Prediction Rule a randomized Clinical trial
    Spine, 2009
    Co-Authors: Joshua A Cleland, Julie M Fritz, Jake Magel, Sarah L Eberhart, Kornelia Kulig, Todd E Davenport, John D Childs
    Abstract:

    STUDY DESIGN: Randomized Clinical trial. OBJECTIVE: The purpose of this randomized Clinical trial was to examine the generalizability of 3 different manual therapy techniques in a patient population with low back pain that satisfy a Clinical Prediction Rule (CPR). SUMMARY OF BACKGROUND DATA: Recently a CPR that identifies patients with LBP who are likely to respond rapidly and dramatically to thrust manipulation has been developed and validated. The generalizability of the CPR requires further investigation. METHODS: A total of 112 patients were enrolled in the trial and provided demographic information and completed a number of self-report questionnaires including the Oswestry Disability Questionnaire (ODQ) and the Numerical Pain Rating Scale (NPRS) at baseline, 1-week, 4-weeks, and 6-months. Patients were randomly assigned to receive 1 of the 3 manual therapy techniques for 2 consecutive treatment sessions followed by exercise regimen for an additional 3 sessions. We examined the primary aim using a linear mixed model for repeated measures, using the ODQ and NPRS as dependent variables. The hypothesis of interest was the group by time interaction, which was further explored with pair-wise comparisons of the estimated marginal means. RESULTS: There was a significant group x time interaction for the ODQ (P < 0.001) and NPRS scores (P = 0.001). Pair-wise comparisons revealed no differences between the supine thrust manipulation and side-lying thrust manipulation at any follow-up period. Significant differences in the ODQ and NPRS existed at each follow-up between the thrust manipulation and the nonthrust manipulation groups at 1-week and 4-weeks. There was also a significant difference in ODQ scores at 6-months in favor of the thrust groups. CONCLUSION: The results of the study support the generalizability of the CPR to another thrust manipulation technique, but not to the nonthrust manipulation technique that was used in this study. In general, our results also provided support that the CPR can be generalized to different settings from which it was derived and validated. However, additional research is needed to examine this issue.

  • comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a Clinical Prediction Rule a randomized Clinical trial
    Spine, 2009
    Co-Authors: Joshua A Cleland, Julie M Fritz, Jake Magel, Kornelia Kulig, Todd E Davenport, Sarah Eberhart, John D Childs
    Abstract:

    STUDY DESIGN: Randomized Clinical trial. OBJECTIVE: The purpose of this randomized Clinical trial was to examine the generalizability of 3 different manual therapy techniques in a patient population with low back pain that satisfy a Clinical Prediction Rule (CPR). SUMMARY OF BACKGROUND DATA: Recently a CPR that identifies patients with LBP who are likely to respond rapidly and dramatically to thrust manipulation has been developed and validated. The generalizability of the CPR requires further investigation. METHODS: A total of 112 patients were enrolled in the trial and provided demographic information and completed a number of self-report questionnaires including the Oswestry Disability Questionnaire (ODQ) and the Numerical Pain Rating Scale (NPRS) at baseline, 1-week, 4-weeks, and 6-months. Patients were randomly assigned to receive 1 of the 3 manual therapy techniques for 2 consecutive treatment sessions followed by exercise regimen for an additional 3 sessions. We examined the primary aim using a linear mixed model for repeated measures, using the ODQ and NPRS as dependent variables. The hypothesis of interest was the group by time interaction, which was further explored with pair-wise comparisons of the estimated marginal means. RESULTS: There was a significant group x time interaction for the ODQ (P < 0.001) and NPRS scores (P = 0.001). Pair-wise comparisons revealed no differences between the supine thrust manipulation and side-lying thrust manipulation at any follow-up period. Significant differences in the ODQ and NPRS existed at each follow-up between the thrust manipulation and the nonthrust manipulation groups at 1-week and 4-weeks. There was also a significant difference in ODQ scores at 6-months in favor of the thrust groups. CONCLUSION: The results of the study support the generalizability of the CPR to another thrust manipulation technique, but not to the nonthrust manipulation technique that was used in this study. In general, our results also provided support that the CPR can be generalized to different settings from which it was derived and validated. However, additional research is needed to examine this issue.

  • 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
    Physical Therapy, 2007
    Co-Authors: Joshua A Cleland, John D Childs, Julie M Fritz, Julie M Whitman, Sarah L Eberhart
    Abstract:

    To date, no studies have investigated the predictive validity of variables from the initial examination to identify patients with neck pain who are likely to benefit from thoracic spine thrust manipulation. The purpose of this study was to develop a Clinical Prediction Rule (CPR) to identify patients with neck pain who are likely to experience early success from thoracic spine thrust manipulation. Subjects This was a prospective, cohort study of patients with mechanical neck pain who were referred for physical therapy. Methods Subjects underwent a standardized examination and then a series of thoracic spine thrust manipulation techniques. They were classified as having experienced a successful outcome at the second and third sessions based on their perceived recovery. Potential predictor variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for Prediction of treatment success.

  • the use of a lumbar spine manipulation technique by physical therapists in patients who satisfy a Clinical Prediction Rule a case series
    Journal of Orthopaedic & Sports Physical Therapy, 2006
    Co-Authors: Joshua A Cleland, John D Childs, Julie M Fritz, Julie M Whitman, Jessica A Palmer
    Abstract:

    Study Design A case series of patients with low back pain (LBP) who satisfy a Clinical Prediction Rule (CPR). Background A CPR that identifies patients with LBP who are likely to respond with rapid and prolonged reductions in pain and disability following spinal manipulation was developed and recently validated. The CPR developed to predict favorable response to manipulation investigated the effects of only 1 manipulation technique. The accuracy of the CPR for predicting outcomes using other manipulation techniques is not known. The purpose of the case series was to describe the outcomes of patients presenting to physical therapy with LBP who met the CPR and were treated with an alternative lumbar manipulation technique. Case Description Consecutive patients referred to physical therapy who satisfied the eligibility criteria, including the presence of at least 4 of the 5 criteria on the CPR, were invited to participate in the case series. Patients were treated for 2 visits with a side-lying lumbar manipul...

Michele Sterling - One of the best experts on this subject based on the ideXlab platform.

  • agreement is very low between a Clinical Prediction Rule and physiotherapist assessment for classifying the risk of poor recovery of individuals with acute whiplash injury
    Musculoskeletal science and practice, 2019
    Co-Authors: Joan Kelly, Carrie Ritchie, Michele Sterling
    Abstract:

    Abstract Background A prognostic Clinical Prediction Rule (whiplash CPR) has been validated for use in individuals with acute whiplash associated disorders (WAD). The Clinical utility of this tool is unknown. Objectives To investigate: 1) the level of agreement between physiotherapist- and whiplash CPR-determined prognostic risk classification of people with acute WAD; 2) which Clinical findings are used by physiotherapists to classify prognostic risk; and 3) whether physiotherapists plan to differ the number of treatment sessions provided based on prognostic risk classification. Design Pragmatic, observational. Method 38 adults with acute WAD were classified as low, medium, or high risk of poor recovery by their treating physiotherapist (n = 24) at the conclusion of the initial consultation. A weighted Cohen's kappa examined the agreement between physiotherapist estimated risk classification and the whiplash CPR. Physiotherapists' reasons for classification were provided and summarised descriptively. Kruskal-Wallis and post-hoc Dunn's tests compared projected number of treatment sessions between risk subgroups. Results Physiotherapist agreement with the whiplash CPR occurred in 29% of cases (n = 11/38), which was less than what is expected by chance (K = −0.03; 95%CI -0.17 to 0.12). Physiotherapists most frequently considered range of movement (n = 23/38, 61%), a premorbid pain condition (n = 14/38, 37%), response to initial physiotherapy treatment (n = 12/38, 32%), and pain intensity (n = 12/38, 32%) when classifying prognostic risk. The projected number of treatment sessions was not different between risk groups using classifications provided by the physiotherapists (χ2(2) = 2.69, p = 0.26). Conclusions Physiotherapists should consider incorporating the whiplash CPR into current assessment processes to enhance accuracy in prognostic decision-making.

  • external validation of a Clinical Prediction Rule to predict full recovery and ongoing moderate severe disability following acute whiplash injury
    Journal of Orthopaedic & Sports Physical Therapy, 2015
    Co-Authors: Carrie Ritchie, Gwendolen Jull, Joan Hendrikz, James M Elliott, Michele Sterling
    Abstract:

    Study Design Retrospective secondary analysis of data. Objectives To investigate the external validity of the whiplash Clinical Prediction Rule (CPR). Background We recently derived a whiplash CPR to consolidate previously established prognostic factors for poor recovery from a whiplash injury and predicted 2 recovery pathways. Prognostic factors for full recovery were being less than 35 years of age and having an initial Neck Disability Index (NDI) score of 32% or less. Prognostic factors for ongoing moderate/severe pain and disability were being 35 years of age or older, having an initial NDI score of 40% or more, and the presence of hyperarousal symptoms. Validation is required to confirm the reproducibility and accuracy of this CPR. Clinician feedback on the usefulness of the CPR is also important to gauge acceptability. Methods A secondary analysis of data from 101 individuals with acute whiplash-associated disorder who had previously participated in either a randomized controlled Clinical trial or p...

  • derivation of a Clinical Prediction Rule to identify both chronic moderate severe disability and full recovery following whiplash injury
    Pain, 2013
    Co-Authors: Carrie Ritchie, Joan Hendrikz, Justin Kenardy, Michele Sterling
    Abstract:

    Abstract Recovery following a whiplash injury is varied: approximately 50% of individuals fully recover, 25% develop persistent moderate/severe pain and disability, and 25% experience milder levels of disability. Identification of individuals likely to develop moderate/severe disability or to fully recover may help direct therapeutic resources and optimise treatment. A Clinical Prediction Rule (CPR) is a research-generated tool used to predict outcomes such as likelihood of developing moderate/severe disability or experiencing full recovery from whiplash injury. The purpose of this study was to assess the plausibility of developing a CPR. Participants from 2 prospective, longitudinal studies that examined prognostic factors for poor functional recovery following whiplash injury were used to derive this tool. Eight factors, previously identified as predictor variables of poor recovery, were included in the analyses: initial neck disability index (NDI), initial neck pain (visual analogue scale), cold pain threshold, range of neck movement, age, gender, presence of headache, and posttraumatic stress symptoms (Posttraumatic Diagnostic Scale [PDS]). An increased probability of developing chronic moderate/severe disability was predicted in the presence of older age and initially higher levels of NDI and hyperarousal symptoms (PDS) (positive predictive value [PPV] = 71%). The probability of full recovery was increased in younger individuals with initially lower levels of neck disability (PPV = 71%). This study provides initial evidence for a CPR to predict both chronic moderate/severe disability and full recovery following a whiplash injury. Further research is needed to validate the tool, determine the acceptability of the proposed CPR by practitioners, and assess the impact of inclusion in practice.

Borislav D Dimitrov - One of the best experts on this subject based on the ideXlab platform.

  • the ice aki study impact analysis of a Clinical Prediction Rule and electronic aki alert in general medical patients
    PLOS ONE, 2018
    Co-Authors: Luke E Hodgson, Borislav D Dimitrov, Paul Roderick, Richard Venn, Guiqing Yao, Lui G Forni
    Abstract:

    Background Acute kidney injury (AKI) is associated with high mortality and measures to improve risk stratification and early identification have been urgently called for. This study investigated whether an electronic Clinical Prediction Rule (CPR) combined with an AKI e-alert could reduce hospital-acquired AKI (HA-AKI) and improve associated outcomes. Methods and findings A controlled before-and-after study included 30,295 acute medical admissions to two adult non-specialist hospital sites in the South of England (two ten-month time periods, 2014–16); all included patients stayed at least one night and had at least two serum creatinine tests. In the second period at the intervention site a CPR flagged those at risk of AKI and an alert was generated for those with AKI; both alerts incorporated care bundles. Patients were followed-up until death or hospital discharge. Primary outcome was change in incident HA-AKI. Secondary outcomes in those developing HA-AKI included: in-hospital mortality, AKI progression and escalation of care. On difference-in-differences analysis incidence of HA-AKI reduced (odds ratio [OR] 0.990, 95% CI 0.981–1.000, P = 0.049). In-hospital mortality in HA-AKI cases reduced on difference-in-differences analysis (OR 0.924, 95% CI 0.858–0.996, P = 0.038) and unadjusted analysis (27.46% pre vs 21.67% post, OR 0.731, 95% CI 0.560–0.954, P = 0.021). Mortality in those flagged by the CPR significantly reduced (14% pre vs 11% post intervention, P = 0.008). Outcomes for community-acquired AKI (CA-AKI) cases did not change. A number of process measures significantly improved at the intervention site. Limitations include lack of randomization, and generalizability will require future investigation. Conclusions In acute medical admissions a multi-modal intervention, including an electronically integrated CPR alongside an e-alert for those developing HA-AKI improved in-hospital outcomes. CA-AKI outcomes were not affected. The study provides a template for investigations utilising electronically generated Prediction modelling. Further studies should assess generalisability and cost effectiveness. Trial registration Clinicaltrials.org NCT03047382.

  • long term risk of stroke after transient ischaemic attack a hospital based validation of the abcd2 Rule
    BMC Research Notes, 2014
    Co-Authors: Rose Galvin, Penka A Atanassova, Nicola Motterlini, Borislav D Dimitrov, Tom Fahey
    Abstract:

    Background The ABCD2 Clinical Prediction Rule is a seven point summation of Clinical factors independently predictive of stroke risk. The purpose of this cohort study is to validate the ABCD2 Rule in a Bulgarian hospital up to three years after TIA.

  • prognostic value of the abcd2 Clinical Prediction Rule a systematic review and meta analysis
    Family Practice, 2011
    Co-Authors: Rose Galvin, Nicola Motterlini, Borislav D Dimitrov, Colm Geraghty, Tom Fahey
    Abstract:

    Objective. The purpose of this systematic review with meta-analysis is to determine the predictive value of the ABCD2 at 7 and 90 days across three strata of risk. Background. The risk of stroke after transient ischaemic attack (TIA) is significant. The ABCD2 Clinical Prediction Rule is designed to predict early risk of stroke after TIA. A number of independent validation studies have been conducted since the Rule was derived. Methods. A systematic literature search was conducted to identify studies that validated the ABCD2. The derived Rule was used as a predictive model and applied to subsequent validation studies. Comparisons were made between observed and predicted number of strokes stratified by risk group: low (0–3 points), moderate (4–5 points) and high (6–7 points). Pooled results are presented as risk ratios (RRs) with 95% confidence intervals (CIs), in terms of over-Prediction (RR > 1) or under-Prediction (RR Results. We include 16 validation studies. Fourteen studies report 7-day stroke risk (n = 6282, 388 strokes). The ABCD2 Rule correctly predicts occurrence of stroke at 7 days across all three risk strata: low [RR 0.86, 95% CI (0.47–1.58), I2 = 16%], moderate [RR 0.99, 95% CI (0.67–1.47), I2 = 68%] and high [RR 0.84, 95% CI (0.6–1.19), I2 = 46%]. Eleven studies report 90-day stroke risk (n = 6304). There is a non-significant trend towards over-Prediction of stroke in all risk categories at 90 days. There are 426 strokes observed in contrast to a predicted 626 strokes. As the trichotomized ABCD2 score increases, the risk of stroke increases (P 0.05). Conclusion. The ABCD2 is a useful CPR, particularly in relation to 7-day risk of stroke.

  • 045 predicting risk of stroke following tia a systematic review of the validation of abcd2 Clinical Prediction Rule
    Journal of Epidemiology and Community Health, 2010
    Co-Authors: Rose Galvin, Nicola Motterlini, Borislav D Dimitrov, Colm Geraghty, Tom Fahey
    Abstract:

    Introduction Stroke is a leading cause of death and acquired disability in every society in which it has been studied. Stroke and transient ischaemic attack (TIA) arise from identical aetiologies and a number of studies have demonstrated that TIAs carry a significant risk of stroke. Several independent predictors of stroke have been incorporated into models such as the ABCD 2 Clinical Prediction Rule, which is used to predict risk of stroke following TIA. This systematic review assessed the predictive value of the ABCD 2 Rule in relation to 7 and 90 day risk of stroke. Methods A computerised systematic literature search was performed to retrieve articles that validated the ABCD 2 Rule. The original derivation study was used as a predictive model and applied to all validation studies, with observed and predicted number of strokes at 7 and 90 days stratified by risk group (0-3 low, 4-5 moderate, 6-7 high). Results from the studies were pooled and risk ratios (RR) with 95% CI produced. Forest plots were used to graphically display the data. A RR score of 1 represents correct Prediction by the ABCD 2 Rule, 1 over-Prediction. Results Nine validation studies (n=5626) predicted 7 day stroke risk. The ABCD 2 Rule correctly predicted occurrence of stroke at 7 days across all three risk strata: low risk (n=1933) — RR 1.12, 95% CI (0.61 to 2.05); moderate risk (n=2640)—RR 1.11, 95% CI (0.74 to 1.68); high risk (n=1053)—RR 0.98, 95% CI (0.69 to 1.41). There were 318 strokes predicted and 288 strokes observed at 7 days across all three risk strata. Data on five studies (n=4897) were pooled to predict 90 day stroke risk. The ABCD 2 Rule over-predicted the occurrence of stroke across all three risk strata — low risk (n=1660), RR 1.50, 95% CI (0.86 to 2.62); moderate risk (n=2214), RR 2.24, 95% CI (1.29 to 3.91); high risk (n=1033), RR 2.00, 95% CI (0.90 to 4.45). There were 268 strokes observed at 90 days in contrast to 404 predicted strokes. The chi-squared trend for analysis indicated that as the trichotomised ABCD 2 score increased, the rate of stroke increased (p Conclusion The ABCD 2 score correctly predicts 7 day risk of stroke across all risk strata but over-predicts 90 day risk of stroke in all groups. The variation in the study setting and design needs to be considered in the interpretation of these findings. ABCD 2 is a useful CPR, particularly in relation to 7 day risk of stroke.