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Derivation of a clinical decision guide in the diagnosis of cervical facet joint pain.

Publication ,  Journal Article
Schneider, GM; Jull, G; Thomas, K; Smith, A; Emery, C; Faris, P; Cook, C; Frizzell, B; Salo, P
Published in: Arch Phys Med Rehabil
September 2014

OBJECTIVE: To derive a clinical decision guide (CDG) to identify patients best suited for cervical diagnostic facet joint blocks. DESIGN: Prospective cohort study. SETTING: Pain management center. PARTICIPANTS: Consecutive patients with neck pain (N=125) referred to an interventional pain management center were approached to participate. INTERVENTIONS: Subjects underwent a standardized testing protocol, performed by a physiotherapist, prior to receiving diagnostic facet joint blocks. All subjects received the reference standard diagnostic facet joint block protocol, namely controlled medial branch blocks (MBBs). The physicians performing the MBBs were blinded to the local anesthetic used and findings of the clinical tests. MAIN OUTCOME MEASURES: Multivariate regression analyses were performed in the derivation of the CDGs. Sensitivity, specificity, positive and negative likelihood ratios, and 95% confidence intervals (CIs) were calculated for the index tests and CDGs. RESULTS: A CDG involving the findings of the manual spinal examination (MSE), palpation for segmental tenderness (PST), and extension-rotation (ER) test demonstrated a specificity of 84% (95% CI, 77-90) and a positive likelihood ratio of 4.94 (95% CI, 2.8-8.2). Sensitivity of the PST and MSE were 94% (95% CI, 90-98) and 92% (95% CI, 88-97), respectively. Negative findings on the PST were associated with a negative likelihood ratio of .08 (95% CI, .03-.24). CONCLUSIONS: MSE, PST, and ER may be useful tests in identifying patients suitable for diagnostic facet joint blocks. Further research is needed to validate the CDGs prior to their routine use in clinical practice.

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Published In

Arch Phys Med Rehabil

DOI

EISSN

1532-821X

Publication Date

September 2014

Volume

95

Issue

9

Start / End Page

1695 / 1701

Location

United States

Related Subject Headings

  • Zygapophyseal Joint
  • Sensitivity and Specificity
  • Rotation
  • Rehabilitation
  • Range of Motion, Articular
  • Prospective Studies
  • Physical Examination
  • Pain Measurement
  • Neck Pain
  • Middle Aged
 

Citation

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ICMJE
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Schneider, G. M., Jull, G., Thomas, K., Smith, A., Emery, C., Faris, P., … Salo, P. (2014). Derivation of a clinical decision guide in the diagnosis of cervical facet joint pain. Arch Phys Med Rehabil, 95(9), 1695–1701. https://doi.org/10.1016/j.apmr.2014.02.026
Schneider, Geoff M., Gwendolen Jull, Kenneth Thomas, Ashley Smith, Carolyn Emery, Peter Faris, Chad Cook, Bevan Frizzell, and Paul Salo. “Derivation of a clinical decision guide in the diagnosis of cervical facet joint pain.Arch Phys Med Rehabil 95, no. 9 (September 2014): 1695–1701. https://doi.org/10.1016/j.apmr.2014.02.026.
Schneider GM, Jull G, Thomas K, Smith A, Emery C, Faris P, et al. Derivation of a clinical decision guide in the diagnosis of cervical facet joint pain. Arch Phys Med Rehabil. 2014 Sep;95(9):1695–701.
Schneider, Geoff M., et al. “Derivation of a clinical decision guide in the diagnosis of cervical facet joint pain.Arch Phys Med Rehabil, vol. 95, no. 9, Sept. 2014, pp. 1695–701. Pubmed, doi:10.1016/j.apmr.2014.02.026.
Schneider GM, Jull G, Thomas K, Smith A, Emery C, Faris P, Cook C, Frizzell B, Salo P. Derivation of a clinical decision guide in the diagnosis of cervical facet joint pain. Arch Phys Med Rehabil. 2014 Sep;95(9):1695–1701.
Journal cover image

Published In

Arch Phys Med Rehabil

DOI

EISSN

1532-821X

Publication Date

September 2014

Volume

95

Issue

9

Start / End Page

1695 / 1701

Location

United States

Related Subject Headings

  • Zygapophyseal Joint
  • Sensitivity and Specificity
  • Rotation
  • Rehabilitation
  • Range of Motion, Articular
  • Prospective Studies
  • Physical Examination
  • Pain Measurement
  • Neck Pain
  • Middle Aged