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STUDY DESIGN: 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. SUMMARY OF BACKGROUND DATA: 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. CONCLUSION: Further investigation of symptom responses in spinal pain is needed before their use can be recommended.

Original publication

DOI

10.1097/brs.0b013e3181b43a41

Type

Journal article

Journal

Spine

Publication Date

11/2009

Volume

34

Pages

2686 - 2699

Addresses

Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom. A.Chorti@warwick.ac.uk

Keywords

Humans, Spinal Diseases, Low Back Pain, Neurologic Examination, Pain Measurement, Prognosis, Sensitivity and Specificity, Predictive Value of Tests, Evidence-Based Medicine, Decision Support Techniques, Point-of-Care Systems