Clinical Prediction Rules
Clinical Prediction Rules (CPRs)
CPRs are mathematical tools that are intended to guide physiotherapists in their everyday clinical decision making . CPRs provide physiotherapists with an evidence-based tool to assist in patient management when determining a particular diagnosis or prognosis, or when predicting a response to a particular intervention. In other words, CPRs are diagnostic, prognostic, or interventional/prescriptive. To date, the large majority of CPRs within the physiotherpay literature are prescriptive in nature . The popularity of CPRs has increased greatly over the past few years .
In many ways much of the art of physiotherapy boils down to playing the percentages and predicting 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 order the objective assessment tests that they think are the most likely to support or refute their various differential diagnoses. With each new piece of the puzzle some hypotheses will become more likely and others less likely. At the end of the assessment the physiotherapist will decide which intervention is likely to result in the optimal outcome for the patient, based on the information they have collected .
Given that the above process is the underlying principle of physiotherapy clinical practice, and bearing in mind the ever increasing time constraints imposed on physiotherapists, it is unsurprising that a great deal of work has been done to facilitate physiotherapists and patients to make decisions. This work in referred to by many names: CPRs, prediction rules, probability assessments, prediction models, decision rules, risk scores, etc. All describe the combination of multiple predictors, such as patient characteristics and investigation results, to estimate the probability of certain outcomes or to identify which treatment is most likely to be effective .
Despite the increasing popularity of CPRs, they are not without limitations and should be subjected to the scientific scrutiny of continued methodological sound research. Despite the fact that the majority of CPRs useful to physiotherapists exist in the initial stages of development, in the absense of strong evidence, they are capable of proving useful information to the physiotherpaist that may in turn enhance patient outcomes. CPRs should not be constructed as removal of the clinical decision-making process from physiotherpay practice. Instead, they should be used to elimiate some of the uncertainty that occurs with each and every clinical encounter and provide a level of evidnce on which physiotherapists can make decisions with adequate confidence. The idea is to stick with the principles of evidence-based practice, and to incorporate the best availalbe evidnce (including CPRs) combined with clinical expertise and patient preference to improve the overall quality of care provided to individual patients .
Prescriptive CPRs are an exponent of the treatment-based system. In this type of diagnostic classification system, a cluster of signs and symtoms from the patient history and physical examination is used to classify patients into subgroups with specific implications for management. As such, it produces homogenous subgroups where all patients within that group are expected to respond favourably to a matched intevention .
- 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
- 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