Back in 2011 when I started to study for my Orthopedic Specialist exam I encountered for the first time Clinical Prediction Rules (CPR). Now those rules are built within the education of emerging Physical Therapists. I started to treat differently after that point but not for reasons you may think. For the most part I wanted to use these physical therapy prediction rules but I still felt there was a lot of gray area or larger “risks” that weren’t accounted for. But…I acknowledge many of the physical findings. For example, hip ROM, or lack there of, is a significant LBP component. My first focus on treating is ensuring that patients have adequate hip ROM.
As CPRs emerge in all domains of health care there will be continuity of clinical actions in patient presentations. There is strong evidence that CPRs have better results than clinical theory and decision making. However, there are still disadvantages in these early stages. For one, there are multiple CPRs for the same pathology. And most CPRs have not gone through extensive outcome analysis where they have developed long term comparisons nor been evaluated by using RCTs at multiple sites.
To read more on this topic, check out: Simon Adams article at BMJ.com.