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Clinical Decision Support Tools for Selecting Interventions for Patients with Disabling Musculoskeletal Disorders: A

Douglas P Gross1, Susan Armijo-Olivo2, William S Shaw3

  • 1Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada. dgross@ualberta.ca.

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Summary

This scoping review identified 43 clinical decision support (CDS) tools for musculoskeletal (MSK) disorders. Current evidence for these tools is preliminary, requiring further validation before widespread implementation.

Keywords:
Back painDecision support techniquesDecision-makingMusculoskeletalReturn to workSick leave

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Area of Science:

  • Health Informatics
  • Clinical Decision Support Systems
  • Musculoskeletal Disorders Management

Background:

  • Front-line staff require effective tools to guide intervention selection for patients with musculoskeletal (MSK) disorders.
  • Clinical decision support (CDS) systems offer potential solutions for optimizing MSK care pathways.
  • A comprehensive inventory and evaluation of existing CDS tools are needed.

Purpose of the Study:

  • To identify and inventory clinical decision support (CDS) tools designed for front-line staff managing patients with musculoskeletal (MSK) disorders.
  • To categorize the types of CDS tools available and assess the current state of their evidentiary support.

Main Methods:

  • A systematic scoping review was conducted using the Arksey and O'Malley framework.
  • Searches across health care, computing science, and business databases identified 4605 manuscripts.
  • A rigorous screening process (92.3% agreement) identified 123 relevant articles detailing 43 CDS tools.

Main Results:

  • 43 CDS tools were identified and classified into three categories: computer-based tools/questionnaires (19%), treatment algorithms/models (33%), and clinical prediction rules/classification systems (49%).
  • The evidentiary support for these CDS tools is currently preliminary.
  • Key limitations include a lack of external validation, head-to-head comparisons, and demonstrated generalizability.

Conclusions:

  • Clinical decision support (CDS) tools, particularly those leveraging advanced computer technologies, are emerging for MSK disorder management.
  • These tools show potential for healthcare providers, case management organizations, and care funders.
  • Further rigorous validation is essential before recommending large-scale implementation of these CDS tools for MSK patient management.