Six Externally Validated Prognostic Models Have Potential Clinical Value to Predict Patient Health Outcomes in the Rehabilitation of Musculoskeletal Conditions: A Systematic Review

Abstract

Objective The purpose of this systematic review was to identify and appraise externally validated prognostic models to predict a patient’s health outcomes relevant to physical rehabilitation of musculoskeletal conditions. Methods We systematically reviewed 8 databases and reported our findings according to PRISMA 2020. An information specialist designed a search strategy to identify externally validated prognostic models for musculoskeletal conditions. Paired reviewers independently screened the title, abstract, full-text and conducted data extraction. We extracted characteristics of included studies (eg, country, study design), prognostic models (eg, performance measures, type of model) and predicted clinical outcomes (eg, pain, disability). We assessed the risk of bias and concerns of applicability using the Prediction model Risk of Bias Assessment Tool (PROBAST). We proposed and used a 5-step method to determine which prognostic models were clinically valuable. Results We found 4896 citations, read 300 full-text articles, and included 46 papers (37 distinct models). Prognostic models were externally validated for the spine, upper limb, lower limb conditions, and musculoskeletal trauma, injuries, and pain. All studies presented a high risk of bias. Half of the models showed low concerns for applicability. Reporting of calibration and discrimination performance measures were often lacking. We found 6 externally validated models with adequate measures which could be deemed clinically valuable [ie, 1) STart Back Screening Tool, 2) WORRK model, 3) Da Silva model, 4) PICKUP model, 5) Schellingerhout rule and 6) Keene model]. Despite having a high risk of bias, which is mostly explained by the very conservative properties of the PROBAST tool, the 6 models remain clinically relevant. Conclusions We found 6 externally validated prognostic models developed to predict patients’ health outcomes that were clinically relevant to the physical rehabilitation of musculoskeletal conditions. Impact Our results provide clinicians with externally validated prognostic models to help them better predict patients’ clinical outcomes and facilitate personalized treatment plans. Incorporating clinically valuable prognostic models could inherently improve the value of care provided by physical therapists.

Establishing the prognostic profile of patients with work‐related musculoskeletal disorders: Development and acceptability of the MAPS questionnaire

“…The preliminary version of the MAPS questionnaire was developed based on a recent pilot study conducted by the research team that required the combination of sociodemographic characteristics, clinical data and outcome measures with prognostic value (Longtin et al., 2021; Naye et al., 2022). A literature search was performed through systematic review by our research team as a preliminary step toward the development of the questionnaire (Naye et al., 2023; Tousignant‐Laflamme et al., 2023). From these results, validated prognostic tools for musculoskeletal rehabilitation and PF of musculoskeletal disorders were extracted to determine the preliminary content items of the MAPS questionnaire.…”

“…Our recent systematic review concluded that validated prognostic models are available to help manage musculoskeletal disorders (Naye et al., 2023). Moreover, there are overviews of systematic reviews that clearly identify potential PF pertaining to musculoskeletal disorders (Nieminen et al., 2021; Otero‐Ketterer et al., 2022).…”

Reproducibility and content validity of the Slovenian version of the STarT Back Screening Tool for chronicity risk assessment in patients with low back pain

“…Despite its limitations, SBT has important clinical benefits. In a comprehensive systematic review, Naye et al [33] ranked it as one of six potentially clinically useful prognostic models for patients with musculoskeletal disorders whose external validity was investigated.…”

What factors do physical therapists consider when determining patient prognosis: A mixed methods study

“…duration of symptoms, pain intensity) (Artus, Campbell, Mallen, Dunn, & van der Windt, 2017;Beattie & Nelson, 2007;Bruls, Bastiaenen, & de Bie, 2015;Martin et al, 2000) and work-related disorders (Tousignant-Laflamme et al, 2023) have been identified. A recent review identified six externally validated prognostic models that predicted health outcomes relevant to the physical rehabilitation of general musculoskeletal conditions (Naye et al, 2023). The review expressed concern that using these models can be complex, especially when determining the suitability of a given model for their practice environment (Naye et al, 2023).…”

“…A recent review identified six externally validated prognostic models that predicted health outcomes relevant to the physical rehabilitation of general musculoskeletal conditions (Naye et al., 2023). The review expressed concern that using these models can be complex, especially when determining the suitability of a given model for their practice environment (Naye et al., 2023). These limitations, and the time required to complete the prognostic tools are likely why they have not been routinely adopted into clinical practice.…”