Systematic review of randomized controlled trials of clinical prediction rules for physical therapy in low back pain

STUDY DESIGN: Systematic review.

OBJECTIVE: To evaluate randomized controlled trials validating the effects of a clinical prediction rule for patients with non-specific low back pain (LBP). The outcomes of interest were any back pain or pain-related measures.

SUMMARY OF BACKGROUND DATA: LBP is a common and costly condition. Interventions for back pain seem to have, at best, small to moderate mean beneficial effects. Identifying subgroups of patients who may respond better to certain treatments may help to improve clinical outcomes in back pain. The development of clinical prediction rules is an attempt to determine who will respond best to certain treatments.

METHODS: We conducted electronic searches of MEDLINE (1980-2009), EMBASE (1980-2009), PsycINFO (1980-2009), Allied and Complementary Medicine (1980-2009), PubMed (1980-2009), ISI Web of Knowledge (1980-2009), and the Cochrane Library (1980-2009). The reference lists of relevant articles were searched for further references.

RESULTS: We identified 1821 potential citations; 3 articles were included. The results from the available data do not support the use of clinical prediction rules in the management of non-specific LBP.

CONCLUSION: There is a lack of good quality randomized controlled trials validating the effects of a clinical prediction rule for LBP. Furthermore, there is no agreement on appropriate methodology for the validation and impact analysis. The evidence for, and development of, the existing prediction rules is generally weak.