Existing validated clinical prediction rules for predicting response to physiotherapy interventions for musculoskeletal conditions have limited clinical value: A systematic review

To systematically review clinical prediction rules (CPRs) that have undergone validation testing for predicting response to physiotherapy-related interventions for musculoskeletal conditions. PubMed, EMBASE, CINAHL and Cochrane Library were systematically searched to September 2020. Search terms inc...

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Bibliographic Details
Published in:Journal of clinical epidemiology 2021-07, Vol.135, p.90-102
Main Authors: Walsh, Mary E., French, Helen P., Wallace, Emma, Madden, Sarah, King, Patricia, Fahey, Tom, Galvin, Rose
Format: Article
Language:English
Subjects:
Back pain
Bias
Calibration
Carpal tunnel syndrome
Clinical outcomes
Clinical prediction rule
Derivation
Epidemiology
Health services
Impact analysis
Manipulative therapy
Musculoskeletal
Outcome
Overuse injuries
Pain
Patients
Physical therapy
Physiotherapy
Predictions
Systematic review
Treatment response
Validation
Validation studies
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Summary:To systematically review clinical prediction rules (CPRs) that have undergone validation testing for predicting response to physiotherapy-related interventions for musculoskeletal conditions. PubMed, EMBASE, CINAHL and Cochrane Library were systematically searched to September 2020. Search terms included musculoskeletal (MSK) conditions, physiotherapy interventions and clinical prediction rules. Controlled studies that validated a prescriptive CPR for physiotherapy treatment response in musculoskeletal conditions were included. Two independent reviewers assessed eligibility. Original derivation studies of each CPR were identified. Risk of bias was assessed with the PROBAST tool (derivation studies) and the Cochrane Effective Practice and Organisation of Care group criteria (validation studies). Nine studies aimed to validate seven prescriptive CPRs for treatment response for MSK conditions including back pain, neck pain, shoulder pain and carpal tunnel syndrome. Treatments included manipulation, traction and exercise. Seven studies failed to demonstrate an association between CPR prediction and outcome. Methodological quality of derivation studies was poor and for validation studies was good overall. Results do not support the use of any CPRs identified to aid physiotherapy treatment selection for common musculoskeletal conditions, due to methodological shortcomings in the derivation studies and lack of association between CPR and outcome in validation studies.
ISSN:0895-4356
1878-5921
DOI:10.1016/j.jclinepi.2021.02.005