European Spine Journal

, Volume 17, Issue 10, pp 1401–1402 | Cite as

Letter to the editor concerning “Independent evaluation of a clinical prediction rule for spinal manipulative therapy: a randomised controlled trial” (M. Hancock et al.)

  • Jeffrey J. HebertEmail author
  • Stephen M. Perle
Letter to the Editor

To the Editor:

We congratulate Hancock and colleagues for undertaking a randomized trial which in part, examined the effectiveness of an eclectic approach to manual therapy for non-specific low back pain (LBP) [8]. These results were reported elsewhere and demonstrate that individuals with non-specific LBP, who receive paracetamol and advice from a general medical practitioner, do not experience a shortened time to recovery with the addition of diclofenac or an assortment of manual therapy techniques.

The authors carried out a secondary analysis of this data [9] to evaluate the performance of a clinical prediction rule [3], which identifies individuals who have a high probability of achieving clinical success with a combination of a spinal manipulation technique and therapeutic exercise. It appears in part, that the authors sought to determine whether the prediction rule would also identify patients with LBP who experience clinical success with treatment consisting of a diverse...


Clinical Success Manual Therapy Prediction Rule Spinal Manipulation Spinal Manipulative Therapy 
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  1. 1.
    Childs JD et al (2004) A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med 141(12):920–928PubMedGoogle Scholar
  2. 2.
    Cleland JA et al (2006) The use of a lumbar spine manipulation technique by physical therapists in patients who satisfy a clinical prediction rule: a case series. J Orthop Sports Phys Ther 36(4):209–214PubMedGoogle Scholar
  3. 3.
    Flynn T et al (2002) A clinical prediction rule for classifying patients with low back pain who demonstrate short term improvement with spinal manipulation. Spine 27:2835–2843PubMedCrossRefGoogle Scholar
  4. 4.
    Flynn TW et al (2008) Manual physical therapy: we speak gibberish. J Orthop Sports Phys Ther 38(3):97–98PubMedGoogle Scholar
  5. 5.
    Fritz JM, Childs JD, Flynn TW (2005) Pragmatic application of a clinical prediction rule in spinal manipulation intervention primary care to identify patients with low back pain with a good prognosis following a brief spinal manipulation intervention. BMC Fam Pract 6(1):29PubMedCrossRefGoogle Scholar
  6. 6.
    Fritz JM, Brennan GP, Leaman H (2006) Does the evidence for spinal manipulation translate into better outcomes in routine clinical care for patients with occupational low back pain? A case-control study. Spine J 6(3):289–295PubMedCrossRefGoogle Scholar
  7. 7.
    Fritz JM, Cleland JA, Childs JD (2007) Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther 37(6):290–302PubMedGoogle Scholar
  8. 8.
    Hancock MJ et al (2007) Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial. Lancet 370(9599):1638–1643PubMedCrossRefGoogle Scholar
  9. 9.
    Hancock MJ et al (2008) Independent evaluation of a clinical prediction rule for spinal manipulative therapy: a randomised controlled trial. Eur Spine J (in press)Google Scholar
  10. 10.
    Kent P et al (2005) Does clinician treatment choice improve the outcomes of manual therapy for nonspecific low back pain? A metaanalysis. J Manipulative Physiol Ther 28(5):312–322PubMedCrossRefGoogle Scholar
  11. 11.
    Vega CP (2008) NSAIDs and Manipulation ineffective for acute low back pain: a best evidence review. Best Evid Rev. Available at Accessed 10 May 2008

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.College of HealthUniversity of UtahSalt Lake CityUSA
  2. 2.College of ChiropracticUniversity of BridgeportBridgeportUSA

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