Assessing Patient Response to Therapeutic Exercise Based on Clinical Prediction Rule (CPR) for Spinal Manipulation

With the trends in health care focusing on treatment effectiveness, it is important for
physical therapists to select the most appropriate intervention according to patient
classification. Physical therapy interventions for management of LBP include therapeutic
exercises and spinal manipulation.

The purpose of this study is to determine whether patients who fit the Clinical Prediction
Rule (CPR) for spinal manipulation may respond instead to exercise according to repeated
lumbar movements in the direction of preference.

The subjects for this study will be comprised of individuals referred for treatment of low
back pain and data will be collected by physical therapists with certification in MDT who
had experience treating patients through the use of spinal manipulation. Patient functional
questionnaires and impairment measures will be used to analyze the patient's perceived level
of function and outcome.

Following the completion of an informed consent, subjects will undergo a physical therapy
examination by a licensed physical therapist. Patients will be included in the study if
they meet the CPR for spinal manipulation as describe in earlier research 6,11. Following
the examination, all qualified subjects will be randomly assigned to either the (1) spinal
manipulation group or (2) the McKenzie (MDT) group and will receive treatment in accordance
with their assigned group. The assessment tools administered at the initial examination
will be readministered for follow-up analysis.