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Prescriptive clinical prediction rules in back pain research: a systematic review.
The Journal of Manual & Manipulative Therapy
|January 5, 2010
Summary
Clinical prediction rules (CPRs) for back pain lack robust validation. Most CPRs require further evaluation before clinical use, with limited evidence supporting their general application in spinal care.
Area of Science:
- Clinical Epidemiology
- Musculoskeletal Disorders
Background:
- Clinical prediction rules (CPRs) aid in matching patients with back pain to optimal interventions.
- Existing CPRs for back pain lack systematic review and rigorous evaluation.
Purpose of the Study:
- To systematically evaluate the quality and development of existing CPRs for back pain.
- To assess the evidence supporting the clinical utility of various CPRs for spinal conditions.
Main Methods:
- A systematic review of Medline was conducted up to June 2008.
- 16 studies evaluating 9 different CPRs for back pain interventions were reviewed.
Main Results:
- Derivation studies for CPRs were generally high quality, but validation studies were consistently low quality.
- None of the reviewed CPRs met the lowest level of evidence hierarchy for clinical application.
- Evidence for manipulation CPRs was limited and contradictory; stabilization CPRs showed limited, cautious applicability.
Conclusions:
- Most CPRs for back pain require further rigorous evaluation before clinical implementation.
- There is currently limited evidence to support the widespread clinical application of spinal CPRs.