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

Affiliation

Walsh ME(1), French HP(2), Wallace E(3), Madden S(4), King P(4), Fahey T(3), Galvin R(5).
Author information:
(1)HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland
(RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland; School of Physiotherapy, Royal College of Surgeons in Ireland
(RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland.
(2)School of Physiotherapy, Royal College of Surgeons in Ireland
(RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland. Electronic address: [Email]
(3)HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland
(RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland.
(4)School of Physiotherapy, Royal College of Surgeons in Ireland
(RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland.
(5)HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland
(RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland; School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Republic of Ireland.

Abstract

OBJECTIVE: To systematically review clinical prediction rules (CPRs) that have undergone validation testing for predicting response to physiotherapy-related interventions for musculoskeletal conditions. STUDY DESIGN AND SETTING: 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). RESULTS: 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. CONCLUSION: 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.