Avail Consulting Inc. - Do Clinical Prediction Rules Work?

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"Clinical Prediction Rules: Do They Work?"

If you aren't familiar with Clinical Prediction Rules (CPRs), you probably should be. They have become a hot topic within the physical therapy research in the past few years and it's time to take a fair and balanced look at them.

CPRs have been around a while and previously have been used in medicine to help physicians better classify and manage patients, but have only showed up in the PT literature for around 5-6 years. They are at the forefront of evidence-based practice research.

A simple way of understanding what CPRs are is thes: If your patient presents with complaint of 'X', and has cluster signs, positive test findings and other variables such as 'a', 'b', 'c', and 'd', then you could implement a specific treatment and expect with a high degreee of probability that they would have a predictable outcome.

It is a tool to aid in clinical decision making by statistically combining clinical finding sto improve the accuracy of diagnosis, prognosis, or prediction of response to treatment for patients.

Now, the good and bad...

Sounds awesome to have such a tool right?

Well, for various orthopedic conditions, this would be exactly what we need. To be able to rapidly find four or five variables that wehn combined allow you to NOT have to scratch your head figuring out what to do, would be fantastic. This type of information would set us further apart from chiropractic and other wanna-be therapy delivery persons.

To remove arbitrary "noise" from the patient evaluation and relyon probabilities would certainly make clinical decision making easier.

However...

When it comes to LBP, there is little homogeneity amongst patients in our clinics which can make application of the rules difficult in real clinical practice.
Few (if any) of the CPR studies have had validation studies (much less a longitudinal or comparateive outcome studies) examining them to see whether or not they are clinically useful (as of 2009) .
A fair amount of work in the classification of LBP indicates that fear-avoidance is behaviors are a recurring theme in treating patients as well as in outcomes. What this means is yet unclear.
We are relying on math to do our jobs in developing the CPRs; this assumes that the data input into them was reliable and valid (i.e. truthful). And...we don't even know if they are designed correctly.

And the biggest question is:

"..are they clinically valid and will they improve care?"

I've heard and read arguments on both sides.

For now, you don't have to wait for a CPR to be anointed to begin using. They either work or they don't. Your patients will decide for you.

We'll cover more about them at the course you must attend.

Today, start looking at which of your patients with LBP also have a concomitant reduction in hip rotation and abduction ipsilateral to the LBP. (Some have it contralateral, but lets just put our toe in the water)

This is a tell sign that when combined with certain tests that have been validated will suggest manipulation to the low back/pelvis will help.

For full details, register today.

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