CPR for Patients with Neck Pain to Benefit from Traction and Exercise

By: Francois Prizinski, DPT, OCS
Raney et al developed a CPR to identify patients with neck pain who would benefit from cervical traction and exercise.
The study included 80 patients with neck pain who recieved 6 sessions of intermittent cervical traction and exercises (2x/wk for 3weeks).  5 variables were identified from regression analysis:
1.) patient reported peripheralization with lower cervical spine (C4-7) mobility testing
2.) positive shoulder abduction test
3.) age >/= 55
4.) positive ULTT A
5.) positive neck distraction
CPR Predictor of Traction/Exercise Outcome
>4/5………. 94.8% Probability of Success
>3/5………..79.2% Probability of Success
>2/5……….. 53.2% Probability of Success
>1/5…………47.6% Probability of Success
>4/5 of the identified variables in this study reported a positive likelihood ratio of 23.1.
This study is not without flaws. The study does not claim to be a validation of the CPR and only identifies a subgroup of patients to benefit from traction and exercise. I am not sure why the authors grouped traction with exercise when traction seems to be the interesting contribution. The “exercises” that were included in this study were DNF endurance training and the classic postural training of the “scapular down and back” training. Furthermore, the scapular posture training was to be performed 2x/hour. That is a pretty amazing variable to contribute to improvements on the global rating scale!
While this study does attempt to contribute to the CPRs that are out there for matching impairments to treatments it would have been nice to see if traction was the true improvement in the global rating scale or if it was simply from performing a posture correction 2x/hr.
Did cervical traction really make the difference for these 80 patients in 3 weeks? Maybe.
Raney N, Petersen EJ, Smith TA, Cowan JE, Rendeiro DG, Deyle GD, Childs JD. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J 2009;18:382-39

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