Original article The relationship between chief complaint and comparable sign in patients with spinal pain: An exploratory study Chad Cook a, * , Kenneth Learman b , Chris Showalter c , Bryan O'Halloran d a Division of Physical Therapy, Duke University, Durham, NC, USA b Division of Physical Therapy, Youngstown State University, Youngstown, OH, USA c Maitland Australian Physiotherapy Seminars, Cutchogue, NY, USA d Pain Relief and Physical Therapy, Havertown, PA, USA article info Article history: Received 5 June 2014 Received in revised form 11 November 2014 Accepted 17 November 2014 Keywords: Comparable sign Low back pain Neck pain Manual therapy abstract Many musculoskeletal management philosophies advocate the exploration of the relationship between the patient's chief complaint (CC) and the physical examination findings that reproduce/reduce/change that CC. Geoffrey Maitland developed the concept “comparable sign(s) (CS), which are physical exami- nation findings related to the CC(s) that are reproduced during an examination/treatment. These include observed abnormalities of movement, postures or motor control, abnormal responses to movement, static deformities, and abnormal joint assessment findings. There are no studies that have explored the potential clinical relationships between the patient's CC and a CS, thus this exploratory study evaluated the associations, outcomes, and prevalence of the findings. This cohort study involved 112 subjects age 54.3 years (SD ¼ 13.4 years), with neck (25.9%) or low back pain (74.1%) who were treated with phys- iotherapy for an average of 42 days. Data analysis revealed 88.4% identified a CC at baseline. There was a moderate statistical association between CC and the active physiological finding of a CS (r ¼ 0.36), and small-moderate associations between all examination phases (r ¼ 0.25e0.37). There were no statistical differences in pain and disability outcomes for those with and without a CC or CS; however, baseline pain levels were higher for those without CC (p ¼ 0.04). Further, rate of recovery was lower in those without a CS during passive physiological examination. The results would suggest that there may be content val- idity to the concept of CS but further research with larger samples sizes is required to explore the extent of the validity is warranted. © 2014 Elsevier Ltd. All rights reserved. 1. Introduction Within clinical practice, the term chief complaint (CC) is used to describe reports of symptoms from the patient during the patient history. Many musculoskeletal management philosophies espouse the importance of recognizing the CC of the patient and then identifying elements of the physical examination that influence the chief complaint. These philosophies are well documented in or- thopedic/manual therapy textbooks (Stoddard, 1969; Cyriax, 1975; Maitland et al., 2001; Dutton, 2013; Cook et al., 2014). It is believed that establishing primary symptom(s) and the movement patterns impacting those symptoms initiates the process of determining whether the problem may be amenable to manual therapy care. Cyriax (1975) emphasized the significance of establishing the physical complement to the patient's CC as the “correct symptom”. Maitland developed the concept comparable sign(s) (CS) over many years and presented these ideas in his clinical teaching and publi- cations (Maitland, 1963, 1983). According to Maitland, a CS refers to the “combination of pain, stiffness, motor response or other findings which the examiner discovers on physical examination and considers being comparable with the patient's symptoms as described in the subjective examination”. Clinically, a CS is integrated with the pa- tient's CC and the coordinated identification of both is often used to direct treatment application (Maitland et al., 2001). At present, despite that the introduction of the concept of the CS was over 50 years ago there are no studies that have investigated the relationship of a CS with a chief complaint. This may be related to the complex multifactorial nature of an examination or the fact * Corresponding author. Doctor of Physical Therapy Division, Duke University School of Medicine 104002, 2200 West Main Street, Suite B-230, Durham NC, 27708, USA. E-mail addresses: chadedwardcook@gmail.com, chad.cook@duke.edu (C. Cook). Contents lists available at ScienceDirect Manual Therapy journal homepage: www.elsevier.com/math http://dx.doi.org/10.1016/j.math.2014.11.007 1356-689X/© 2014 Elsevier Ltd. All rights reserved. Manual Therapy xxx (2014) 1e5 Please cite this article in press as: Cook C, et al., The relationship between chief complaint and comparable sign in patients with spinal pain: An exploratory study, Manual Therapy (2014), http://dx.doi.org/10.1016/j.math.2014.11.007