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Open Access Commentary

Clinical decision rules, spinal pain classification and prediction of treatment outcome: A discussion of recent reports in the rehabilitation literature

Jeffrey J Hebert1* and Julie M Fritz2

Author Affiliations

1 Faculty of Health Sciences, Murdoch University, Murdoch, WA, Australia

2 Department of Physical Therapy, University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA

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Chiropractic & Manual Therapies 2012, 20:19  doi:10.1186/2045-709X-20-19

Published: 22 June 2012

Abstract

Clinical decision rules are an increasingly common presence in the biomedical literature and represent one strategy of enhancing clinical-decision making with the goal of improving the efficiency and effectiveness of healthcare delivery. In the context of rehabilitation research, clinical decision rules have been predominantly aimed at classifying patients by predicting their treatment response to specific therapies. Traditionally, recommendations for developing clinical decision rules propose a multistep process (derivation, validation, impact analysis) using defined methodology. Research efforts aimed at developing a “diagnosis-based clinical decision rule” have departed from this convention. Recent publications in this line of research have used the modified terminology “diagnosis-based clinical decision guide.” Modifications to terminology and methodology surrounding clinical decision rules can make it more difficult for clinicians to recognize the level of evidence associated with a decision rule and understand how this evidence should be implemented to inform patient care. We provide a brief overview of clinical decision rule development in the context of the rehabilitation literature and two specific papers recently published in Chiropractic and Manual Therapies.

Keywords:
Diagnosis; Clinical prediction rule; Clinical decision making; Low back pain; Neck pain; Back pain