We all use this model in one way or another in clinical practice.  Either it being assessing overall pain level, improved shoulder ROM, more ease with sit to stand transition or simply positive changes in gait.  From a more specific manual standpoint, I routinely assess pain response following a treatment most often, but also pain provocation threshold to palpation and improved mobility/range in the direction of dysfunction.  

What brings this up is from Manual Therapy’s newly published article by Cook et al entitled, “Can a within/between-session change in pain during reassessment predict outcome using a manual therapy intervention in patients with mechanical low back pain?”

What I got mostly out of this article is a change of 2-points or greater is not only indicative of obviously pain relief (more often than not main reason the patient sought PT care) that has been shown in the past to be clinically significant, but that it is related to functional improvement.  Prior to now, I have only anecdotally known this, but now there is a RCT to give my feelings a backbone. 

Even though 50% reduction in ODI (clinically important outcome) was only found in 67% of cases in this study, I can use this data in my daily SOAP assessments to further show that the 2 point or greater reduction in pain (or more as we should hope to get more than 2 pt change in NRPS!) is not only clinically significantly from a pain level scale, but has shown to be a functional improvement too. We can all jump and down now. Insurances will like this.  I like it too, as I don’t have to get the patient to fill out ODI as often!


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