Validation of a clinical prediction rule for the effect of mechanical cervical traction

• Main Authors: Shan-Ju Lin, 林珊如
• Other Authors: Tzyy-Jiuan Wang
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/34103711800529347775

碩士 === 國立陽明大學 === 物理治療暨輔助科技學系 === 98 === Background and purpose: Mechanical cervical traction is a widely accepted therapeutic modality for the treatment of neck pain. However, conflicting evidence exists about the effectiveness of cervical traction. Systematic reviews have not confirmed the effectiveness of mechanical cervical traction. More clinical studies with good quality are needed to confirm the effects of mechanical cervical traction. Identifying the traction subgroup is important. In a previous study, we have developed a prediction rule containing five significant predictors of response to cervical traction for treating mechanical neck pain. These predictors included “female”, “had sensory deficits found with corresponding dermatome”, “needed to perform repetitive work with upper extremities > 1 hr/day”, “symptom worse as the day went on”, and “initial pain score more than 5.5.” However, these predictors have not been validated in a true experimental study. Therefore, the purpose of the study is to validate this clinical prediction rule in patients with neck pain. Methods: The study design was a double-blind randomized controlled trial. Subjects with neck pain were recruited to participate in this clinical study. Procedure: After initial evaluation and physical examination, patients were randomly assigned into either the traction group or the control group. The traction group received hot pack, electrical therapy and cervical traction. The control group only received hot pack and electrical therapy. After one time treatment, we evaluated the immediate treatment effect on pain, neck range of motion, etc. Data analysis: Either ANCOVA or ANOVA was used to determine the immediate effects between four subgroups which were formed according to the previous clinical prediction rule. Results: One hundred and twenty subjects were recruited in this study. Patients who were positive on the prediction rule (at least 3 of 5 criteria met) demonstrated significantly more improvement in pain, perceived improvement, and function than those who were negative on the rule but received cervical traction and than those who did not receive cervical traction (the control group). Conclusion: Patients with neck pain demonstrated more improvement after receiving mechanical cervical traction if they were positive on the prediction rule. The predictors we developed can help make clinical decision for the use of cervical traction. Key words: mechanical cervical traction, clinical prediction rule, validation, neck pain