Derivation of a Clinical Decision Guide in the Diagnosis of Cervical Facet Joint Pain
Date
2013-06-14
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Abstract
Neck pain is a common problem presenting to health care professionals in a primary care setting. In particular, the facet joint has been implicated as a primary source of pain in 36% - 67% of people with persistent neck pain. The most internationally accepted criterion standard for the diagnosis of facet joint pain is comparative controlled injections of local anaesthetic onto the sensory nerve of the target facet joint. This procedure is invasive, costly, and is often associated with lengthy wait-times. Clinicians often apply findings from the patient history and physical examination prior to referral of their patients for diagnostic facet joint blocks. The diagnostic utility of the clinical examination has raised controversy in the literature.
The purpose of this thesis was to derive a clinical decision guide in the diagnosis of cervical facet joint pain. Our research revealed that the manual spinal examination, palpation for segmental tenderness, and extension-rotation tests possess moderate to excellent intra-rater and inter-rater reliability. Our research indicated that positive findings on all three clinical tests might be helpful for clinicians when attempting to identify patients who may respond positively to diagnostic facet joint blocks. Of interest, the manual spinal examination and palpation for segmental tenderness test may be useful screening procedures, as they possessed high sensitivity and low negative likelihood ratios. Future research, in independent samples, is needed to validate our findings or generate other decision guides that are optimal for clinicians to deliver high quality care for their patients with persistent neck pain.
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Medicine and Surgery, Rehabilitation and Therapy
Citation
Schneider, G. M. (2013). Derivation of a Clinical Decision Guide in the Diagnosis of Cervical Facet Joint Pain (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/25559