title: The relationship between chief complaint and comparable sign in patients with spinal pain: An exploratory study.
abstract: Many musculoskeletal management philosophies advocate the exploration of the relationship between the patient's chief complaint (CC) and the physical examination findings that reproduce/reduce/change that CC. Geoffrey Maitland developed the concept "comparable sign(s) (CS), which are physical examination findings related to the CC(s) that are reproduced during an examination/treatment. These include observed abnormalities of movement, postures or motor control, abnormal responses to movement, static deformities, and abnormal joint assessment findings. There are no studies that have explored the potential clinical relationships between the patient's CC and a CS, thus this exploratory study evaluated the associations, outcomes, and prevalence of the findings. This cohort study involved 112 subjects age 54.3 years (SD = 13.4 years), with neck (25.9%) or low back pain (74.1%) who were treated with physiotherapy for an average of 42 days. Data analysis revealed 88.4% identified a CC at baseline. There was a moderate statistical association between CC and the active physiological finding of a CS (r = 0.36), and small-moderate associations between all examination phases (r = 0.25-0.37). There were no statistical differences in pain and disability outcomes for those with and without a CC or CS; however, baseline pain levels were higher for those without CC (p = 0.04). Further, rate of recovery was lower in those without a CS during passive physiological examination. The results would suggest that there may be content validity to the concept of CS but further research with larger samples sizes is required to explore the extent of the validity is warranted.
authors.affiliation: Division of Physical Therapy, Duke University, Durham, NC, USA. Electronic address: chadedwardcook@gmail.com.
authors.forename: Chad
authors.initials: C
authors.lastname: Cook
authors.affiliation: Division of Physical Therapy, Youngstown State University, Youngstown, OH, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Learman
authors.affiliation: Maitland Australian Physiotherapy Seminars, Cutchogue, NY, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Showalter
authors.affiliation: Pain Relief and Physical Therapy, Havertown, PA, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: O'Halloran
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods*; D017288:Pain Threshold; D010808:Physical Examination / Q000379:methods*; D059825:Physical Therapists; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018434:Sickness Impact Profile
keywords: Comparable sign; Low back pain; Manual therapy; Neck pain