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Figure 1.

Results of the decision tree analysis of the patient characteristics that best define the clinical scenarios where mobilization was rated inappropriate

CNP = chronic neck (cervical) pain


1Red flags = Those factors where the risk may outweigh the benefit, such as:

  • fever greater than 100 degrees F;
  • prolonged corticosteroid use;
  • unexplained weight loss;
  • history of cancer;
  • history of serious systemic inflammatory arthritides or vasculitides;
  • endocrinopathies that affect calcium metabolism.

  • 2Major neurologic findings = At least one of the following:

  • neurologic signs of cervical myelopathy;
  • progressive unilateral muscle weakness and/or motor loss documented by repeat exam over time;
  • sensory deficits other than related to dermatomes or peripheral nerves;
  • and/or electrodiagnostic findings of acute and/or progressive radiculopathy.

  • 3Minor neurologic findings = At least one of the following:

  • asymmetrically decreased reflexes in upper extremity;
  • documented dermatomal or peripheral nerve sensory changes which may include deficit, paresthesia, and hyperesthesia;
  • non-progressive unilateral muscle weakness and/or parasthesia that follows a radicular pattern.