Saturday, March 7, 2009

Develping a CPR (clinical prediction rule) for PFPS depending on Lumbopelvic manipulation.

Quadriceps muscle function in patients with PFPS was recently shown to improve following treatment with lumbopelvic manipulation. No previous study has determined if individuals with PFPS experience symptomatic relief of activity-related pain immediately following this manipulation technique.

Iverson CA et al tried to determine the predictive validity of selected clinical exam items and to develop a clinical prediction rule (CPR) to determine which patients with patellofemoral pain syndrome (PFPS) have a positive immediate response to lumbopelvic manipulation.

Sample & method:
1. 50 subjects (26 male, 24 female; age range, 18-45 years) with PFPS underwent a standardized history and physical examination.
2. After the evaluation, each subject performed 3 typically pain-producing functional activities (squatting, stepping up a 20-cm step, and stepping down a 20-cm step).
3. The pain level perceived during each activity was rated on a numerical pain scale (0 representing no pain and 10 the worst possible pain).
4. Following the assessment, all subjects were treated with a lumbopelvic manipulation, which was immediately followed by retesting the 3 functional activities to determine if there was any change in pain ratings.
5. An immediate overall 50% or greater reduction in pain, or moderate or greater improvement on a global rating of change questionnaire, was considered a treatment success.
6. Likelihood ratios (LRs) were calculated to determine which examination items were most predictive of treatment outcome.

Result & conclusion:
1. Out of 49 subjects who were included in the data analysis, 22 (45%) had a successful outcome.
2. Five predictor variables were identified. The most powerful predictor of treatment success was a side-to-side difference in hip internal rotation range of motion greater than 14 masculine (+LR, 4.9).
3. If this variable was present, the chance of experiencing a successful outcome improved from 45% to 80%.

Reference:
Iverson CA et al J Orthop Sports Phys Ther. 2008 Jun;38(6):297-309; discussion 309-12. Epub 2008 Jan 22.

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