Haskins Robin, Rivett Darren A, Osmotherly Peter G
School of Health Sciences, The University of Newcastle, NSW 2308, Australia.
Man Ther. 2012 Feb;17(1):9-21. doi: 10.1016/j.math.2011.05.001. Epub 2011 Jun 8.
To identify, appraise and determine the clinical readiness of diagnostic, prescriptive and prognostic Clinical Prediction Rules (CPRs) in the physiotherapy management of Low Back Pain (LBP).
MEDLINE, EMBASE, CINAHL, AMED and the Cochrane Database of Systematic Reviews were searched from 1990 to January 2010 using sensitive search strategies for identifying CPR and LBP studies. Citation tracking and hand-searching of relevant journals were used as supplemental strategies.
Two independent reviewers used a two-phase selection procedure to identify studies that explicitly aimed to develop one or more CPRs involving the physiotherapy management of LBP. Diagnostic, prescriptive and prognostic studies investigating CPRs at any stage of their development, derivation, validation, or impact-analysis, were considered for inclusion using a priori criteria. 7453 unique records were screened with 23 studies composing the final included sample.
Two reviewers independently extracted relevant data into evidence tables using a standardised instrument.
Identified studies were qualitatively synthesized. No attempt was made to statistically pool the results of individual studies. The 23 scientifically admissible studies described the development of 25 unique CPRs, including 15 diagnostic, 7 prescriptive and 3 prognostic rules. The majority (65%) of studies described the initial derivation of one or more CPRs. No studies investigating the impact phase of rule development were identified.
The current body of evidence does not enable confident direct clinical application of any of the identified CPRs. Further validation studies utilizing appropriate research designs and rigorous methodology are required to determine the performance and generalizability of the derived CPRs to other patient populations, clinicians and clinical settings.
识别、评估并确定用于腰痛（LBP）物理治疗管理的诊断、处方和预后临床预测规则（CPR）的临床适用性。
1990年至2010年1月期间，使用敏感的检索策略在MEDLINE、EMBASE、CINAHL、AMED和Cochrane系统评价数据库中检索识别CPR和LBP研究的文献。引用追踪和相关期刊的手工检索用作补充策略。
两名独立评审员采用两阶段选择程序来识别明确旨在开发一个或多个涉及LBP物理治疗管理的CPR的研究。使用预先设定的标准，纳入在CPR开发、推导、验证或影响分析的任何阶段研究CPR的诊断、处方和预后研究。筛选了7453条独特记录，最终纳入样本包括23项研究。
两名评审员使用标准化工具独立将相关数据提取到证据表中。
对识别出的研究进行定性综合。未尝试对个体研究结果进行统计合并。23项科学上可接受的研究描述了25条独特CPR的开发，包括15条诊断规则、7条处方规则和3条预后规则。大多数（65%）研究描述了一个或多个CPR的初始推导。未识别出研究规则开发影响阶段的研究。
目前的证据不足以支持对任何已识别的CPR进行可靠的直接临床应用。需要利用适当的研究设计和严格的方法进行进一步的验证研究，以确定所推导CPR在其他患者群体、临床医生和临床环境中的性能和可推广性。
