Clinical Prediction Rules Flashcards
(29 cards)
Clinical Prediction Rule for Thoracic Mobilization with Neck Pain
1) Symptoms less than 30 days
2) No symptoms past the shoulder
3) Looking up does not aggravate symptoms
4) FABQ-PA <12
5) Diminished t-spine kyphosis
6) Cervical extension < 30 degrees
Clinical Prediction Rule for Thoracic Mobilization with Shoulder Pain
1) Pain free shoulder flexion < 127 degrees
2) Shoulder IR < 53 degrees in 90 degrees of ABD
3) Negative Neer Impingement Test
4) No meds for shoulder pain
5) Symptoms less than 90 days
What screening questions for malignancy have the highest sensitivity?
1) Age under 50
2) Unexplained changes in weight
3) Failure to improve with conservative treatment
4) Previous personal history of cancer
Sensitivity 1.0 and -LR .06
Name the three special tests for the shoulder that have the highest post-test probability for dx of a full thickness rotator cuff tear.
1) Drop arm test
2) Painful arc sign
3) Infraspinatus muscle test
Name the criteria for ‘high risk’ under the Canadian Cervical Spine rule.
1) Age over 65
2) Dangerous mechanism of injury
3) Paresthesias in extremities
Name the Low Risk criteria for the Canadian Cervical Spine Rule AND if they answer yes, what is the next follow-up exam
1) Simple rear end MVC
2) Ambulatory at any time
3) Ability to sit upright in ED
4) Delayed onset of neck pain
5) Absence of midline c-spine tenderness
Follow up if YES
Able to rotate Left and Right at least 45 degrees
Clinical Prediction Rule for cervical patients that are likely to respond to traction.
1) Peripheralization with lower cervical spine mobility testing
2) Positive shoulder abduction test
3) Age LESS THAN 55
4) Positive ULNT testing-median bias (A)
5) Positive neck distraction test
Greater than or equal to 4 of these variables +LR of 23.1
Greater than or equal to 3 of these variables +LR of 4.81
Clinical Prediction Rule for Dx Cervical Radiculopathy
1) Positive upper limb tension test (A)
2) Cervical rotation < 60 degrees to the involved side
3) Positive Spurling’s
4) Positive Distraction
5) Myotome and dermatome changes on exam
Clinical Prediction Rule for Dx of Carpal Tunnel Syndrome
1) Shaking hands reduces symptoms
2) Wrist ratio GREATER THAN 0.67
3) Symptom severity scale GREATER THAN 1.9
4) Diminished sensation in the median sensory field (thumb)
5) Age >45 years old
5 Positive +LR of 18.3
4 Positive +LR of 4.6
Clinical Prediction Rule for Meniscal Pathology
1) Hx of catching or locking
2) Joint line tenderness
3) Pain with forced hyper extension (modified bounce home test)
4) Pain with maximal knee flexion
5) Pain or audible click with McMurray’s maneuver
Ottawa Ankle Rule for Radiographs
1) Bony tenderness along distal 6 cm of posterior edge of fibula OR tip of lateral malleolus.
2) Bony tenderness along distal 6 cm of posterior edge of tibia/tip of medial malleolus.
3) Bony tenderness at the base of the 5th metatarsal
4) Bony tenderness at the navicular
5) Inability to bear weight immediately after injury AND 4 step during initial evaluation
Ottawa Knee Rule
1) Age >=55
2) Isolated patella tenderness
3) Tenderness at head of fibula
4) Inability to flex the knee greater than 90 degrees
5) Inability to bear weight immediately after injury and in ED
Best combination of tests to RULE-IN subacromial impingement
1) Painful arc
2) Empty can
3) External rotation resistance
Best combination of tests to RULE-OUT subacromial impingement
1) Painful arc
2) External rotation resistance
Diagnostic cluster for ‘Shoulder Impingement’
1) Hawkins-Kennedy impingement sign
2) Painful arc sign
3) Infraspinatus muscle test
+LR of 10.56 for SOME type of impingement
Lumbar Instability Test Cluster
1) Age LESS than 40 years old
2) SLR greater than 91 degrees
3) Aberrant motion present
4) Positive prone instability test
5) Patient’s who are post-partum
3+ Sensitivity 0.56 and Specificity 0.86
+LR 4.0 and -LR 0.52
Clinical Prediction Rule for IMPROVEMENT with Lumbar Stabilization
1) FABQ-PA greater than 9 points
2) Aberrant movement ABSENT
3) No hyper-mobility with spring testing
4) Negative prone instability test
Clinical Prediction Rule for Hip Mobilization in presence of Knee Pain
1) Hip or groin pain OR parasthesias
2) Ipsilateral anterior thigh pain
3) Passive knee flexion <122 degrees
4) Passive hip IR <17 degrees
5) Pain with hip distraction
Most useful provocation tests for the SI joint
1) dorsolateral provocation (strongest +LR)
2) thigh thrust test (most sensitive)
3) ventromedial provocation in side lying (most specific)
4) sacral thrust at S2
* 5) Gaenslen test in supine
3 or more positive suggests SI joint involvement
Diagnostic cluster for hip micro instability
HEER Test
AB-HEER Test
Prone Hip Instability Test
Foot Progression Walking Test
Moderate-Weak Clinical Value
Cluster of Sutlive for Hip OA
Hip Scour Test Passive hip IR less than 25 Pain with squatting Active hip flexion causes lateral pain Active hip extension causes pain
Moderate clinical validity
Neck Pain with Mobility Deficits: Predictors for Success with Manual therapy
1) NDI less than 11.5
2) bilateral involvement pattern
3) no sedentary work greater than 5 hours per day
4) neck movement improves pain
5) no increase in pain with neck extension
6) history of spondylitis without radiculopathy
Neck pain with Mobility Deficits: Predictors for favorable response to manipulation
1) Symptoms less than 38 days
2) Expectation that manipulation will help
3) Difference in rotational ROM greater than or equal to 10 degrees
4) Pain reproduced with P/A’s in mid c-spine
Neck Pain with Radiating Pain: predictors of short-term improvements
1) Age < 54
2) Dominant arm was not affected
3) Symptoms did not worsen looking down
4) Multimodal treatment with manual therapy, cervical traction and DNF strengthening for at least 50% of visits
