Clinical Prediction Rules

What are clinical prediction rules?

Clinical prediciton rules are mathematical tools that are intended to guide physiotherapists in their clinical decision making. The popularity of such rules has increases greatly over the past few years (reference).

In many ways much of the art of physiotherapy boils down to playing the percentages and predicitng outcomes. For example, when physiotherapists do a subjective assessment with a patient they ask the questions that they think are the most likely to provide them with the information they need to make a diagnosis. They might then when doing the objective assessment with the patient order the tests that they think are the most likely to support or refute their various differential diagnoses. With each new piece of information some diagnoses will become more likely and others less likely. At the end of the asssessmnet the physiotherapist will decide which treatment(s) is most likely to result in the optimal outcome for the patient, based on the information they have obtained (reference).

The intent of CPRs is to assist clinicians in making a diagnosis, establishing a prognosis, or implementing an intervention. It has been suggested that well-constructed CPRs can improve clinical decision making and practice, there is a lack of consensus as to what constitutes a methodologically sound CPR. 

Establishing a clinical prediction rule

The establishment of a clinical prediction rule in clinical practice requires four distinct phases:

1. Development - Identification of predictors from an observational study
2. Validation - testing of the clinical prediction rule in a seperate population to see if it remains reliable
3. Impact analysis - measurement of the usefulness of the rule in the clinical setting in terms of cost-benefit, patient satisfaction, time/resource allocation, etc

CPRs

Diagnosis

• Canadian Cervical Spine Rules
• Carpal Tunnel Syndrome
• Cervical Radiculopathy
• Deep Vein Thrombosis
• Meniscal Pathology
• Ottawa Ankle Rules
• Ottawa Knee Rules
• Pittsburgh Knee Rules
• Pulmonary Embolism
• Rotator Cuff Pathology
• Subacromial Impingement

Intervention

• Cervicothoracic Manipulation for Shoulder Pain
• CPR for Lumbar Stabilisation
• Hip Mobilization for Knee Osteoarthritis
• Manipulation for Low Back Pain
• Mechanical Traction for Low Back Pain
• Mechanical Traction for Neck Pain
• Manipulation for Patellofemoral Pain Syndrome
• Orthotics for Patellofemoral Pain Syndrome
• Patellar Taping for Patellofemoral Pain Syndrome
• Stabilization for Low Back Pain
• Thoracic Manipulation for Neck Pain
• Cervical Manipulation for Neck Pain

Resources

http://orthopedicmanualpt.com/clinical-decision-making/clinical-prediction-rules/