Execution
- 1Confirm the patient has low back pain appropriate for considering manipulation and no contraindications.
- 2Check whether symptom duration is less than 16 days.
- 3Check whether symptoms do not extend distal to the knee.
- 4Record whether FABQ work subscale score is less than 19.
- 5Measure whether at least one hip has more than 35° internal rotation and assess whether at least one lumbar segment is hypomobile, then counts positive criteria.
Positive outcome
The rule is positive when four or more of the five criteria are present. A positive rule predicts a higher probability of short-term improvement with lumbar manipulation. It is not a diagnostic test for facet joint pain.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Flynn et al. (2002) | NA | NA | NA | 24.38 | NA |
| Childs et al. (2004) — validation study | NA | NA | NA | 13.2 | NA |
CommentThis is a treatment-response prediction rule, not a facet-joint diagnostic test. It appears in this pathology area because manipulation and facet / joint dysfunction historically overlap in clinical reasoning. The original and validation studies show strong short-term prediction when the rule is positive, but it should not override contraindication screening or patient preference.
High Clinical Value