Review

A diagnosis-based clinical decision rule for spinal pain part 2: review of the literature

Donald R Murphy^1,2,3 , Eric L Hurwitz⁴ and Craig F Nelson⁵

¹  Rhode Island Spine Center, 600 Pawtucket Avenue, Pawtucket, RI, 02860, USA

²  Department of Community Health, Warren Alpert Medical School of Brown University, USA

³  Research Department, New York Chiropractic College, USA

⁴  Department of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii at Mânoa, Honolulu, Hawaii, 96822, USA

⁵  American Specialty Health, San Diego, CA, USA

author email corresponding author email

Chiropractic & Osteopathy 2008, 16:7doi:10.1186/1746-1340-16-7

Published:	11 August 2008

Abstract

Background

Spinal pain is a common and often disabling problem. The research on various treatments for spinal pain has, for the most part, suggested that while several interventions have demonstrated mild to moderate short-term benefit, no single treatment has a major impact on either pain or disability. There is great need for more accurate diagnosis in patients with spinal pain. In a previous paper, the theoretical model of a diagnosis-based clinical decision rule was presented. The approach is designed to provide the clinician with a strategy for arriving at a specific working diagnosis from which treatment decisions can be made. It is based on three questions of diagnosis. In the current paper, the literature on the reliability and validity of the assessment procedures that are included in the diagnosis-based clinical decision rule is presented.

Methods

The databases of Medline, Cinahl, Embase and MANTIS were searched for studies that evaluated the reliability and validity of clinic-based diagnostic procedures for patients with spinal pain that have relevance for questions 2 (which investigates characteristics of the pain source) and 3 (which investigates perpetuating factors of the pain experience). In addition, the reference list of identified papers and authors' libraries were searched.

Results

A total of 1769 articles were retrieved, of which 138 were deemed relevant. Fifty-one studies related to reliability and 76 related to validity. One study evaluated both reliability and validity.

Conclusion

Regarding some aspects of the DBCDR, there are a number of studies that allow the clinician to have a reasonable degree of confidence in his or her findings. This is particularly true for centralization signs, neurodynamic signs and psychological perpetuating factors. There are other aspects of the DBCDR in which a lesser degree of confidence is warranted, and in which further research is needed.