The Future of Clinical Prediction Rules

Question

Where do you see CPRs headed in the future of Physical Therapy?

Answer

I see us coming to some convergence on some of the controversies that surrounds CPRs.  First of all, on what to call them. Do we keep calling them CPRs which sounds like, "Annie, Annie, are you OK?" Do we call them Clinical Decision Rules which the Brits like to call them? Do we call them Clinical Prediction Guides - CPGs?  That is problematic because it sounds like a Clinical Practice Guideline which also uses the abbreviation CPGs. Nobody even knows what abbreviation to use consistently.

I think that once people get out there and start publishing books-  This book [Glynn PE, Weisbach PC. Clinical Prediction Rules: A Physical Therapy Reference Manual. Boston: Jones &Bartlett; 2011.] published last year by Glynn and Weisbach is going to have an influence.  You will start seeing those books show up in PT schools and people will learn the nomenclature. Glynn and Weisbach call them Clinical Prediction Rules. So, I think there will be a convergence in the nomenclature.  

And I think there will also be some resolution in some of the other controversies which are pretty interesting.  They are fairly polarized. I myself submitted a letter to the editor when the Australian group of authors lead by Hancock, Herbert and Maher [Physical Therapy 2009 89:1009-110;doi:10.2522/ptj.2009.89.10.100] submitted a very strong criticism of all existing interventional CPRs in Physical Therapy.  They basically called them all junk. (I may be being too harsh there.)  But that was the bottom line saying that they were all derived from single-arm trials, and you can't trust any of them. They are no good.  I submitted a response - a letter to the editor - and they replied back. It is interesting that there are differing perceptions and differing opinions among experts about the direction that we are headed with this. But I think the debate is healthy, and that we will see a resolution of this debate over time.  It is an evolution, so a 10 year timeframe is interesting.  10 years ago, we had zero.  No one had even thought about using this approach or developing these tools for Physical Therapists to use to make clinical decisions. The next 10 years should probably see even more change and perhaps even more clarity about accepted standards for this stuff.