Kenneth Learman

Publications (2)4.64 Total impact

• Article: Early use of thrust manipulation versus non-thrust manipulation: A randomized clinical trial.

  Chad Cook, Kenneth Learman, Chris Showalter, Vincent Kabbaz, Bryan O'Halloran
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  ABSTRACT: The purpose of this study was to investigate the comparative effectiveness of early use of thrust (TM) and non-thrust manipulation (NTM) in sample of patients with mechanical low back pain (LBP). The randomized controlled trial included patients with mechanically reproducible LBP, ≥age 18-years who were randomized into two treatment groups. The main outcome measures were the Oswestry Disability Index (ODI) and a Numeric Pain Rating Scale (NPRS), with secondary measures of Rate of Recovery, total visits and days in care, and the work subscale of the Fears Avoidance Beliefs Questionnaire work subscale (FABQ-w). A two-way mixed model MANCOVA was used to compare ODI and pain, at baseline, after visit 2, and at discharge and total visits, days in care, and rate of recovery (while controlling for patient expectations and clinical equipoise). A total of 149 subjects completed the trial and received care over an average of 35 days. There were no significant differences between TM and NTM at the second visit follow-up or at discharge with any of the outcomes categories. Personal equipoise was significantly associated with ODI and pain. The findings suggest that there is no difference between early use of TM or NTM, and secondarily, that personal equipoise affects study outcome. Within-groups changes were significant for both groups.
  Manual therapy 10/2012; · 2.32 Impact Factor
• Article: Does the use of a prescriptive clinical prediction rule increase the likelihood of applying inappropriate treatments? A survey using clinical vignettes.

  Kenneth Learman, Christopher Showalter, Chad Cook
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  ABSTRACT: Clinical prediction rules (CPR) have been promoted as a natural progression in treatment decision-making. Methodological limitations of derivation and validation studies have resulted in some researchers questioning the indiscriminate use of CPRs. The purpose of this study was to explore the influence of the lumbar spine manipulation CPR (LCPR) use on clinical decision making through a survey of practicing clinicians. A sample of 535 physiotherapists from the United States, who routinely use thrust manipulation (TM), agreed to participate in this study. Those who use and those who do not use the LCPR determined group designation. A 9-step clinical vignette progressed a fictitious patient meeting the LCPR from no medical concern to significant concern for general health. A 2 × 9 chi-square was used to analyze the progression of decision-making. APTA board certification (P = 0.04), gender (P < 0.01), and manual therapy course attendance (P = 0.04) may increase and following the McKenzie philosophy (P < 0.01) may decrease the use of the LCPR. Subjects using the LCPR were more likely to choose to manipulate the patient (P < 0.01 and P = 0.02) during the first 2 scenarios of the vignette but both groups avoided TM equally as the medical concerns progressed. The results would suggest that subjects who routinely use TM would modify their decision-making to accommodate medical complications that preclude the indication for TM, and hence a potentially harmful intervention. This propensity to modify behaviour, was seen in both groups, regardless of their initial tendency to use the LCPR.
  Manual therapy 06/2012; 17(6):538-43. · 2.32 Impact Factor