title: Derivation of a clinical decision guide in the diagnosis of cervical facet joint pain.
abstract: OBJECTIVE
  To derive a clinical decision guide (CDG) to identify patients best suited for cervical diagnostic facet joint blocks.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Pain management center.
  
  
  METHODS
  Consecutive patients with neck pain (N=125) referred to an interventional pain management center were approached to participate.
  
  
  METHODS
  Subjects underwent a standardized testing protocol, performed by a physiotherapist, prior to receiving diagnostic facet joint blocks. All subjects received the reference standard diagnostic facet joint block protocol, namely controlled medial branch blocks (MBBs). The physicians performing the MBBs were blinded to the local anesthetic used and findings of the clinical tests.
  
  
  METHODS
  Multivariate regression analyses were performed in the derivation of the CDGs. Sensitivity, specificity, positive and negative likelihood ratios, and 95% confidence intervals (CIs) were calculated for the index tests and CDGs.
  
  
  RESULTS
  A CDG involving the findings of the manual spinal examination (MSE), palpation for segmental tenderness (PST), and extension-rotation (ER) test demonstrated a specificity of 84% (95% CI, 77-90) and a positive likelihood ratio of 4.94 (95% CI, 2.8-8.2). Sensitivity of the PST and MSE were 94% (95% CI, 90-98) and 92% (95% CI, 88-97), respectively. Negative findings on the PST were associated with a negative likelihood ratio of .08 (95% CI, .03-.24).
  
  
  CONCLUSIONS
  MSE, PST, and ER may be useful tests in identifying patients suitable for diagnostic facet joint blocks. Further research is needed to validate the CDGs prior to their routine use in clinical practice.
authors.affiliation: Graduate Sciences Education, Faculty of Medicine, University of Calgary, Calgary, AB, Canada. Electronic address: gm.schneider22@gmail.com.
authors.forename: Geoff M
authors.initials: GM
authors.lastname: Schneider
authors.affiliation: School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia.
authors.forename: Gwendolen
authors.initials: G
authors.lastname: Jull
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Thomas
authors.affiliation: School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia.
authors.forename: Ashley
authors.initials: A
authors.lastname: Smith
authors.affiliation: Sport Injury Prevention Research Center, University of Calgary, Calgary, AB, Canada.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Emery
authors.affiliation: Alberta Health Services Research - Research Excellence Support Team, Foothills Medical Center, Calgary, AB, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Faris
authors.affiliation: Division of Physical Therapy, Walsh University, North Canton, OH.
authors.forename: Chad
authors.initials: C
authors.lastname: Cook
authors.affiliation: Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Bevan
authors.initials: B
authors.lastname: Frizzell
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Salo
mesh_terms: D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000175:diagnosis* / Q000534:rehabilitation; D002574:Cervical Vertebrae; D015331:Cohort Studies; D016001:Confidence Intervals; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis* / Q000534:rehabilitation; D010147:Pain Measurement; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012399:Rotation; D012680:Sensitivity and Specificity; D021801:Zygapophyseal Joint
keywords: Neck pain; Physical examination; Rehabilitation; Sensitivity and specificity