%0 Journal Article
%T Clinical decision rules, spinal pain classification and prediction of treatment outcome: A discussion of recent reports in the rehabilitation literature
%A Jeffrey J Hebert
%A Julie M Fritz
%J Chiropractic & Manual Therapies
%D 2012
%I BioMed Central
%R 10.1186/2045-709x-20-19
%X Healthcare has undergone an important paradigm shift toward evidence based practice; an approach thought to enhance clinical decision making by integrating the best available evidence with clinical expertise and the preferences of patients.[1] Ultimately, the goal of evidence based practice is to improve healthcare delivery. However, the translation of scientific evidence into practice has proven a challenging endeavour.Clinical decision rules (CDRs), also known as clinical prediction rules, are an increasingly common presence in the rehabilitation literature. These are tools designed to inform clinical decision-making by identifying potential predictors of diagnostic test outcome, prognosis or therapeutic response.[2,3] In the rehabilitation literature, CDRs are most commonly used to predict a patient¡¯s response to treatment and have been proposed as a means of identifying clinically relevant subgroups of patients presenting with otherwise heterogeneous disorders such as non-specific neck[4] or low back pain[5,6] and this is the perspective on which we intend to focus.The ability to classify or subgroup patients with heterogeneous disorders such as spinal pain has been highlighted as a research priority[7,8] and consequently, the focus of much research effort. The appeal of such classification approaches is their potential for improved treatment efficiency and effectiveness by matching patients with optimal therapies. In the past, patient classification has relied on implicit approaches founded in tradition or unsystematic observations. The use of CDRs to inform classification is one attempt at a more evidence driven approach, less dependent on unfounded theory.CDRs are developed in a multistep process involving studies of derivation, validation and analysis of impact with each having a defined purpose and methodological criteria.[2,9] As with all forms of evidence used to make decisions about patients, attention to appropriate study methodology is critical to asse
%K Diagnosis
%K Clinical prediction rule
%K Clinical decision making
%K Low back pain
%K Neck pain
%K Back pain
%U http://www.chiromt.com/content/20/1/19