Lumbopelvic manipulation for the treatment of patients with patellofemoral pain syndrome: development of a clinical prediction rule.
METHODS
Prospective cohort/predictive validity study.


OBJECTIVE
To determine the predictive validity of selected clinical exam items and to develop a clinical prediction rule (CPR) to determine which patients with patellofemoral pain syndrome (PFPS) have a positive immediate response to lumbopelvic manipulation.


BACKGROUND
Quadriceps muscle function in patients with PFPS was recently shown to improve following treatment with lumbopelvic manipulation. No previous study has determined if individuals with PFPS experience symptomatic relief of activity-related pain immediately following this manipulation technique.


METHODS
Fifty subjects (26 male, 24 female; age range, 18-45 years) with PFPS underwent a standardized history and physical examination. After the evaluation, each subject performed 3 typically pain-producing functional activities (squatting, stepping up a 20-cm step, and stepping down a 20-cm step). The pain level perceived during each activity was rated on a numerical pain scale (0 representing no pain and 10 the worst possible pain). Following the assessment, all subjects were treated with a lumbopelvic manipulation, which was immediately followed by retesting the 3 functional activities to determine if there was any change in pain ratings. An immediate overall 50% or greater reduction in pain, or moderate or greater improvement on a global rating of change questionnaire, was considered a treatment success. Likelihood ratios (LRs) were calculated to determine which examination items were most predictive of treatment outcome.


RESULTS
Data for 49 subjects were included in the data analysis, of which 22 (45%) had a successful outcome. Five predictor variables were identified. The most powerful predictor of treatment success was a side-to-side difference in hip internal rotation range of motion greater than 14 masculine (+LR, 4.9). If this variable was present, the chance of experiencing a successful outcome improved from 45% to 80%.


CONCLUSIONS
A CPR was developed to predict an immediate successful response to lumbopelvic manipulation in patients with PFPS. However, in light of a limited sample size and omission of potentially meaningful predictor variables, future studies are necessary to validate the CPR.
Blanchfield Army Community Hospital, Fort Campbell, KY, USA.
Christine A
CA
Iverson
Thomas G
TG
Sutlive
Michael S
MS
Crowell
Rebecca L
RL
Morrell
Matthew W
MW
Perkins
Matthew B
MB
Garber
Josef H
JH
Moore
Robert S
RS
Wainner
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D010147:Pain Measurement; D046788:Patellofemoral Pain Syndrome / Q000175:diagnosis* / Q000628:therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires