Clinical Prediction Rules That Don't Hold Up—Where to Go From Here?

Stanton, Tasha R.

doi:10.2519/jospt.2016.0606

Cited by 10 publications

(3 citation statements)

References 37 publications

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“…The clinical prediction rule (or predictive model, probability assessment, decision rule, risk score) [36] is a decision-making tool for clinicians with three or more variables obtained from the history, physical examination, and simple diagnostic tests. They are derived from the data collected directly from patients [36][37][38]. They provide powerful tools to improve clinical decision making [39].…”

Section: Introductionmentioning

confidence: 99%

Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand

et al. 2020

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Background: Early diagnosis of neonatal sepsis is essential to prevent severe complications and avoid unnecessary use of antibiotics. The mortality of neonatal sepsis is over 18%in many countries. This study aimed to develop a predictive model for the diagnosis of bacterial late-onset neonatal sepsis. Methods: A case-control study was conducted at Queen Sirikit National Institute of Child Health, Bangkok, Thailand. Data were derived from the medical records of 52 sepsis cases and 156 non-sepsis controls. Only proven bacterial neonatal sepsis cases were included in the sepsis group. The non-sepsis group consisted of neonates without any infection. Potential predictors consisted of risk factors, clinical conditions, laboratory data, and treatment modalities. The model was developed based on multiple logistic regression analysis. Results: The incidence of late proven neonatal sepsis was 1.46%. The model had 6 significant variables: poor feeding, abnormal heart rate (outside the range 100-180 x/min), abnormal temperature (outside the range 36 o -37.9°C), abnormal oxygen saturation, abnormal leucocytes (according to Manroe's criteria by age), and abnormal pH (outside the range 7.27-7.45). The area below the Receiver Operating Characteristics (ROC) curve was 95.5%. The score had a sensitivity of 88.5% and specificity of 90.4%.Conclusion: A predictive model and a scoring system were developed for proven bacterial late-onset neonatal sepsis. This simpler tool is expected to somewhat replace microbiological culture, especially in resource-limited settings.

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Section: Introductionmentioning

confidence: 99%

Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand

et al. 2020

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“…as treatment effect modifiers) is unwarranted. Second, there are known limitations in the generalizability of CPRs in that devised models are often taken from homogenous samples and not often validated in subsequent samples (Stanton, 2016). However, given that our data came from orthopaedic surgery departments in 14 different institutions, we believe that our model is based on a well-represented, diverse sample.…”

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confidence: 99%

Identifying participants with knee osteoarthritis likely to benefit from physical therapy education and exercise: A hypothesis‐generating study

Tanaka

Nishigami

Wand

et al. 2020

European Journal of Pain

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BackgroundThe purpose of this investigation was to undertake a hypothesis‐generating study to identify candidate variables that characterize people with knee osteoarthritis who are most likely to experience a positive response to exercise.MethodsOne hundred and fifty participants with knee osteoarthritis participated in this observational, longitudinal study. All participants received a standard exercise intervention that consisted of 20‐min sessions two to three times a week for three months. The classification and regression tree methodology (CART) was used to develop prediction of positive clinical outcome. Positive pain and disability outcomes (dependent variables) were defined as an improvement in pain intensity by >50% or an improvement of five or more on the Oxford knee score, respectively. The predictor variables considered included age, sex, body mass index, knee osteoarthritis severity (Kellgren/Lawrence grade), pain duration, use of medication, range of knee motion, pain catastrophizing, self‐efficacy and knee self‐perception.ResultsFifty‐five participants (36.6%) were classified as responders for pain intensity and 36.6% were classified as responders for disability. The CART model identified impairments in knee self‐perception and knee osteoarthritis severity as the discriminators for pain intensity reduction following exercise. No variables predicted reduction of disability level following exercise.ConclusionsSuch findings suggest that both body perception and osteoarthritis severity may play a role in treatment outcome with exercise. It also raises the possibility that those with higher levels of disrupted body perception may need additional treatment targeted at restoring body perception prior to undertaking exercise.SignificanceRegardless age, sex, body mass index, pain duration, use of medication, knee range of motion, pain catastrophizing and self‐efficacy, participants with knee osteoarthritis who report low levels of body perception disruption (a FreKAQ score ≦ 17) and minimal structural changes (KL grade I) demonstrate significantly better outcomes from exercise therapy than other participants.

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“…Even though multiple systematic reviews have raised concerns about the value of these prediction rules and the validation of these tools [ 19 , 88 ], similarly to Puentedura et al, we found that being aware of spine CPRs impacted the beliefs on safety, the perception of effectiveness, and the utilization of SM [ 28 ]. Notably, the fact remains that none of the prescriptive CPRs in physiotherapy are recommended for application in clinical practice as validation and impact analysis studies are still lacking [ 89 ].…”

Section: Discussionmentioning

confidence: 99%

Knowledge, beliefs, and attitudes of spinal manipulation: a cross-sectional survey of Italian physiotherapists

et al. 2022

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Background and Objective High-velocity low-amplitude thrust spinal manipulation (SM) is a recommended and commonly used manual therapy intervention in physiotherapy. Beliefs surrounding the safety and effectiveness of SM have challenged its use, and even advocated for its abandonment. Our study aimed to investigate the knowledge and beliefs surrounding SM by Italian physiotherapists compared with similar practitioners in other countries. Methods An online survey with 41 questions was adapted from previous surveys and was distributed via a mailing list of the Italian Physiotherapists Association (March 22–26, 2020). The questionnaire was divided into 4 sections to capture information on participant demographics, utilization, potential barriers, and knowledge about SM. Questions were differentiated between spinal regions. Attitudes towards different spinal regions, attributes associated with beliefs, and the influence of previous educational background were each evaluated. Results Of the 7398 registered physiotherapists, 575 (7.8%) completed the survey and were included for analysis. The majority of respondents perceived SM as safe and effective when applied to the thoracic (74.1%) and lumbar (72.2%) spines; whereas, a smaller proportion viewed SM to the upper cervical spine (56.8%) as safe and effective. Respondents reported they were less likely to provide and feel comfortable with upper cervical SM (respectively, 27.5% and 48.5%) compared to the thoracic (respectively, 52.2% and 74.8%) and lumbar spines (respectively, 46.3% and 74.3%). Most physiotherapists (70.4%) agreed they would perform additional screening prior to upper cervical SM compared to other spinal regions. Respondents who were aware of clinical prediction rules were more likely to report being comfortable with SM (OR 2.38–3.69) and to perceive it as safe (OR 1.75–3.12). Finally, physiotherapists without musculoskeletal specialization, especially those with a traditional manual therapy background, were more likely to perform additional screening prior to SM, use SM less frequently, report being less comfortable performing SM, and report upper cervical SM as less safe (p < 0.001). Discussion The beliefs and attitudes of physiotherapists surrounding the use of SM are significantly different when comparing the upper cervical spine to other spinal regions. An educational background in traditional manual therapy significantly influences beliefs and attitudes. We propose an updated framework on evidence-based SM.

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Clinical Prediction Rules That Don't Hold Up—Where to Go From Here?

Cited by 10 publications

References 37 publications

Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand

Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand

Identifying participants with knee osteoarthritis likely to benefit from physical therapy education and exercise: A hypothesis‐generating study

Knowledge, beliefs, and attitudes of spinal manipulation: a cross-sectional survey of Italian physiotherapists

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