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Systematic Review of Randomized Controlled Trials of Clinical Prediction Rules for Physical Therapy in Low Back Pain

Patel, Shilpa, C. Psychol*; Friede, Tim, PhD; Froud, Robert, PhD‡,§; Evans, David W., PhD*; Underwood, Martin, MD*

doi: 10.1097/BRS.0b013e31827b158f
Literature Review

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.

Level of Evidence: 1

This article presents the results of a systematic review of randomized controlled trials validating the effects of a clinical prediction rule for patients with nonspecific low back pain.

*University of Warwick, Warwick Clinical Trials Unit, Warwick Medical School, Coventry, United Kingdom

Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany

Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom

§University College of Health Sciences, Campus Kristiania, Oslo, Norway.

Address correspondence and reprint requests to Shilpa Patel, University of Warwick, Clinical Trials Unit, Warwick Medical School, Gibbet Hill Road, Coventry, CV4 7AL, West Midlands, United Kingdom; E-mail:

Acknowledgment date: May 9, 2012. First revision date: October 24, 2012. Acceptance date: October 25, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

This project benefited from facilities funded through Birmingham Science City Translational Medicine Clinical Research and infrastructure Trials platform, with support from Advantage West Midlands.

Relevant financial activities outside the submitted work: consultancy, stock/stock options, travel/accommodations/meeting expenses.

© 2013 Lippincott Williams & Wilkins, Inc.