Clinical Prediction Rules

Question 1

Clinical Prediction Rule for Thoracic Mobilization with Neck Pain

Answer 1

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

Question 2

Clinical Prediction Rule for Thoracic Mobilization with Shoulder Pain

Answer 2

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

Question 3

What screening questions for malignancy have the highest sensitivity?

Answer 3

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

Question 4

Name the three special tests for the shoulder that have the highest post-test probability for dx of a full thickness rotator cuff tear.

Answer 4

1) Drop arm test
2) Painful arc sign
3) Infraspinatus muscle test

Question 5

Name the criteria for ‘high risk’ under the Canadian Cervical Spine rule.

Answer 5

1) Age over 65
2) Dangerous mechanism of injury
3) Paresthesias in extremities

Question 6

Name the Low Risk criteria for the Canadian Cervical Spine Rule AND if they answer yes, what is the next follow-up exam

Answer 6

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

Question 7

Clinical Prediction Rule for cervical patients that are likely to respond to traction.

Answer 7

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

Question 8

Clinical Prediction Rule for Dx Cervical Radiculopathy

Answer 8

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

Question 9

Clinical Prediction Rule for Dx of Carpal Tunnel Syndrome

Answer 9

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

Question 10

Clinical Prediction Rule for Meniscal Pathology

Answer 10

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

Question 11

Ottawa Ankle Rule for Radiographs

Answer 11

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

Question 12

Ottawa Knee Rule

Answer 12

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

Question 13

Best combination of tests to RULE-IN subacromial impingement

Answer 13

1) Painful arc
2) Empty can
3) External rotation resistance

Question 14

Best combination of tests to RULE-OUT subacromial impingement

Answer 14

1) Painful arc

2) External rotation resistance

Question 15

Diagnostic cluster for ‘Shoulder Impingement’

Answer 15

1) Hawkins-Kennedy impingement sign
2) Painful arc sign
3) Infraspinatus muscle test

+LR of 10.56 for SOME type of impingement

Question 16

Lumbar Instability Test Cluster

Answer 16

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

Question 17

Clinical Prediction Rule for IMPROVEMENT with Lumbar Stabilization

Answer 17

1) FABQ-PA greater than 9 points
2) Aberrant movement ABSENT
3) No hyper-mobility with spring testing
4) Negative prone instability test

Question 18

Clinical Prediction Rule for Hip Mobilization in presence of Knee Pain

Answer 18

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

Question 19

Most useful provocation tests for the SI joint

Answer 19

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

Question 20

Diagnostic cluster for hip micro instability

Answer 20

HEER Test
AB-HEER Test
Prone Hip Instability Test
Foot Progression Walking Test

Moderate-Weak Clinical Value

Question 21

Cluster of Sutlive for Hip OA

Answer 21

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

Question 22

Neck Pain with Mobility Deficits: Predictors for Success with Manual therapy

Answer 22

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

Question 23

Neck pain with Mobility Deficits: Predictors for favorable response to manipulation

Answer 23

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

Question 24

Neck Pain with Radiating Pain: predictors of short-term improvements

Answer 24

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

Question 25

Altman Criteria for Hip OA

Answer 25

1) Hip internal rotation less than 15 degrees OR painful hip internal rotation
2) Age > 50
3) Morning stiffness lasting less than 60 minutes

Question 26

Clinical prediction rule to RULE OUT coronary artery disease in primary care.

Answer 26

1) age/sex: female>65, male >55
2) known clinical vascular disease
3) pain worse during exercise
4) pain not reproduced by palpation
5) patient assumes pain is of cardiac origin

Question 27

Lumbar Manipulation Test Cluster

Answer 27

1) Current episode <16 days
2) No symptoms distal to knee
3) FABQ-W <19
4) At least 1 hypomobile segment
5) At least 1 hip IR > 35 degrees

Question 28

Lumbar Traction Test Clusters

Answer 28

Cluster 1

• non involvement in manual work
• low level of FAB
• no neurological deficits
• age > 30

Cluster 2

• pain in the leg
• signs of nerve root compression
• peripheralization of symptoms with ext.
• positive crossed SLR

Question 29

Lumbar Specific Exercise Test Cluster

Answer 29

Extension

• symptoms distal to buttock
• symptoms centralize with ext
• symptoms peripheralize with flex
• directional preference for lumbar extension

Flexion

• Age >50
• imaging evidence of lumbar stenosis
• directional preference for flexion