title: The prognostic value of symptom responses in the conservative management of spinal pain: a systematic review.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  To investigate the prognostic value of clinically induced changes in spinal symptoms (i.e., symptom response) in the conservative management of spinal pain.
  
  
  BACKGROUND
  Symptom response is used by clinicians to inform management decisions. Understanding the prognostic value of symptom response can aid in this decision-making process.
  
  
  METHODS
  A search of Ovid-Medline, Ovid-Embase, Ovid-Cinahl, Ovid-Amed, reference lists and citation tracking was performed. Methodologic quality was assessed independently by 2 raters.
  
  
  RESULTS
  We included 22 articles reporting 18 different cohorts. The evidence was limited and mainly involved low back pain. We found no association between most symptom responses and clinical outcomes. Only for changes in pain location and/or intensity with repeated spinal movement testing or as a response to treatment did the data provide support for use of symptom response to inform management. Further work is needed to confirm these findings. Limited evidence of an association with disability was found for the prone instability test in low back pain patients attending a stabilization program. The evidence for neurodynamic testing was conflicting for low back pain. The strength of identified associations and the extent of confounding between investigated prognostic factors remain uncertain.
  
  
  CONCLUSIONS
  Further investigation of symptom responses in spinal pain is needed before their use can be recommended.
authors.affiliation: Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom. A.Chorti@warwick.ac.uk
authors.forename: Angeliki G
authors.initials: AG
authors.lastname: Chorti
authors.forename: Anastasios G
authors.initials: AG
authors.lastname: Chortis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Strimpakos
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: McCarthy
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lamb
mesh_terms: D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D009460:Neurologic Examination / Q000379:methods; D010147:Pain Measurement / Q000379:methods*; D019095:Point-of-Care Systems / Q000706:statistics & numerical data / Q000639:trends*; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D013122:Spinal Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy