Clinical decision making in the identification of patients likely to benefit from spinal manipulation: a traditional versus an evidence-based approach

Growing evidence suggests that spinal manipulation is effective in the management of low back pain (LBP). However, in the absence of evidence of an alternative approach, clinicians have primarily relied on diagnostic tests with questionable reliability and validity in the clinical decision-making process to identify potential candidates for spinal manipulation. These 2 cases highlight the use of a clinical prediction rule (CPR) developed by Flynn et al, which demonstrates that there are a few simple criteria from the history and physical examination that can be used to help clinicians decide if spinal manipulation and a range of motion (ROM) exercise may be helpful in the management of a patient with LBP. Importantly, these results provide clinicians with an easy-to-use procedure to accurately identify patients with LBP who are likely to achieve a dramatic improvement prior to treatment. We believe this CPR offers clinicians an efficient and practical evidence-based tool that can be applied by even the novice physical therapist who is familiar with the CPR and the technique that was used in its development. This CPR should encourage clinicians who were previously reluctant to incorporate spinal manipulation into their clinical practice to use it more frequently based on a patient's status with respect to the CPR.