A theoretical model for the development of a diagnosis-based clinical decision rule for the management of patients with spinal pain

Abstract

Background: Spinal pain is a common problem, and disability related to spinal pain has great consequence in terms of human suffering, medical costs and costs to society. The traditional approach to the non-surgical management of patients with spinal pain, as well as to research in spinal pain, has been such that the type of treatment any given patient receives is determined more by what type of practitioner he or she sees, rather than by diagnosis. Furthermore, determination of treatment depends more on the type of practitioner than by the needs of the patient. Much needed is an approach to clinical management and research that allows clinicians to base treatment decisions on a reliable and valid diagnostic strategy leading to treatment choices that result in demonstrable outcomes in terms of pain relief and functional improvement. The challenges of diagnosis in patients with spinal pain, however, are that spinal pain is often multifactorial, the factors involved are wide ranging, and for most of these factors there exist no definitive objective tests.

Essential literature for the chiropractic profession: Results and implementation challenges from a survey of international chiropractic faculty

“…25,29,32,34,44,60,62,64,65,72 These teachers cited numerous articles (n ¼ 9) on clinical decision making, such as classification systems, algorithms, or clinical prediction rules. 9,19,42,51,70,102,110,111,149 Recent systematic reviews, clinical guidelines, and best practices related to conservative care of musculoskeletal conditions also garnered many endorsements (n ¼ 9). 37,39,47,109,114,115,118,150,151 Faculty also suggested articles on clinical assessment or training methods (n ¼ 7), case studies (n ¼ 4), outcomes assessment (n ¼ 3), and adverse events (n ¼ 3).…”

“…7 Second in ranking was Bronfort et al, 8 ''Effectiveness of manual therapies: the UK evidence report.'' Five articles received 3 recommendations: ''A theoretical model for the development of a diagnosis-based clinical decision rule for the management of patients with spinal pain'' (Murphy 9 ), ''Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: a systematic review and update of the UK evidence report'' (Clar et al . Twelve additional submissions (11 peer-reviewed articles and 1 book) were recommended twice.…”

Differential diagnosis of shoulder and cervical pain: a case report

“…Murphy and Hurwitz advocate the use of three diagnostic questions as a conceptual basis for a clinical decision making rule in the management of mechanical and non-mechanical musculoskeletal pain. 8 The first question, 'Are the patient's symptoms reflective of a visceral disorder or a serious or potentially life-threatening illness', should trigger the therapist to consider whether the signs and symptoms could be arising from non-mechanical conditions such as cancer of the surrounding bone or soft tissues, visceral pathology, fracture, disease of the gastrointesitinal tract, or seronegative spondyloarthropathy. The second question, 'From where is the patient's pain arising' does not involve narrowly identifying one structural source of the pain; rather, the therapist tries to understand the characteristics about the pain source.…”

To Compare the Effects of Internal Rotation Mobilization of Hip With Conventional Physiotherapy Treatment in Patients With Low Back Pain: Randomized Clinical Trail

“…In spite of this, specific diagnosis and thus treatments of patients with back pain have been elusive. The challenges of diagnosis in patients with back pain are that it is often multifactorial, the factors involved are wide ranging [5]. Scenario in search of the cause of low back pain, a number of investigators have focused on the relationship between hip joint mobility and low back pain.6 There is a logical explanation given in the literature about the pathomechanics of hip internal rotation deficit leading to low back pain [6,7].…”

“…In spite of this, specific diagnosis and thus treatments of patients with back pain have been elusive. The challenges of diagnosis in patients with back pain are that it is often multifactorial, the factors involved are wide ranging [5].…”