A Case Study Examining the Effectiveness of Mechanical Diagnosis and Therapy in a Patient who Met the Clinical Prediction Rule for Spinal Manipulation

Abstract

This single-subject case study was conducted as a part of a randomized trial investigating the efficacy of mechanical diagnosis and therapy (MDT) and spinal thrust manipulation (STM) in patients who meet a clinical prediction rule (CPR) for spinal manipulation. Following initial examination, a patient who met the CPR was treated initially with STM and then eventually with MDT. The Oswestry Disability Questionnaire (ODI), Fear-Avoidance Beliefs Questionnaire, and the Numerical Pain Rating Scale (NPRS) were administered at the initial examination and at a two-week follow-up. Data were analyzed based on changes in the pain rating scale, ODI, and straight leg raise scores from initial examination to discharge. In accordance with a study protocol in which the patient was part of, this patient was changed from STM to MDT after the second physical therapy visit due to failure of overall improvement. The patient received MDT during the third session and continued with this approach until discharge. This patient responded favorably to MDT presenting with a 20 degrees improvement in SLR on the left and 10 degrees on the right, 6 points lower on the NPRS, and a 4% decrease on the OSW after a total of 6 visits.

Utilizing Mulligan Sustained Natural Apophyseal Glides Within a Clinical Prediction Rule for Treatment of Low Back Pain in a Secondary School Football Player

“…The results were similar to a study by Learman et al, 16 who demonstrated a change in NRS scores in three different spinal manipulation groups, averaging 3.6, 3.3, and 2.5. Chen et al 17 reported similar results of an overall NRS change from 6 to 0 following four sessions (two of spinal thrust manipulation and two of mechanical diagnosis and therapy). Cook et al 3 also reported a significant decrease in the total NRS of 3.4 following seven treatments of a nonthrust manipulation technique, and a decrease of 3.3 following six treatments of a thrust manipulation technique.…”

Prevalence of classification methods for patients with lumbar impairments using the McKenzie syndromes, pain pattern, manipulation, and stabilization clinical prediction rules

“…Of interest, there are two case studies comparing MDT versus manipulation CPR classification for a patient with low back pain. 39,40 Both case studies identified patients who met four out of five criteria on the CPR for spinal manipulation as proposed by Flynn et al, 33 and were successfully treated by specific lumbar flexion 40 Because of the lack of data comparing patient classification methods, the overall aim was to begin comparisons of common methods currently used to classify patients during the initial examination with non-specific low back pain typically referred to outpatient physical therapy settings. Specific aims were to: (1) determine the proportion of patients who could be classified by McKenzie syndromes and pain pattern classification using MDT assessment methods and clinical prediction rules for manipulation and stabilization; and (2) within each manipulation and stabilization CPR category, determine classification prevalence rates for McKenzie syndromes and pain pattern categories (PPCs).…”

The addition of manipulation to an extension-oriented intervention for a patient with chronic LBP

“…There is little published research documenting use of the LBP TBC for patients meeting dual classification. Three case reports [19][20][21] have discussed the decision-making and outcomes of patients who have met the criteria for more than one subgroup of the TBC. 7 Thus, the purpose of this report is to describe the evaluation, management, and outcomes of a patient with LBP who met both the manipulation and specific exercise subgroups of the TBC.…”