HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland; School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland.
School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland.
J Clin Epidemiol. 2021 Jul;135:90-102. doi: 10.1016/j.jclinepi.2021.02.005. Epub 2021 Feb 9.
To systematically review clinical prediction rules (CPRs) that have undergone validation testing for predicting response to physiotherapy-related interventions for musculoskeletal conditions.
PubMed, EMBASE, CINAHL and Cochrane Library were systematically searched to September 2020. Search terms included musculoskeletal (MSK) conditions, physiotherapy interventions and clinical prediction rules. Controlled studies that validated a prescriptive CPR for physiotherapy treatment response in musculoskeletal conditions were included. Two independent reviewers assessed eligibility. Original derivation studies of each CPR were identified. Risk of bias was assessed with the PROBAST tool (derivation studies) and the Cochrane Effective Practice and Organisation of Care group criteria (validation studies).
Nine studies aimed to validate seven prescriptive CPRs for treatment response for MSK conditions including back pain, neck pain, shoulder pain and carpal tunnel syndrome. Treatments included manipulation, traction and exercise. Seven studies failed to demonstrate an association between CPR prediction and outcome. Methodological quality of derivation studies was poor and for validation studies was good overall.
Results do not support the use of any CPRs identified to aid physiotherapy treatment selection for common musculoskeletal conditions, due to methodological shortcomings in the derivation studies and lack of association between CPR and outcome in validation studies.
系统评价已接受验证测试的临床预测规则（CPRs），以预测肌肉骨骼疾病物理治疗相关干预措施的反应。
系统检索了 PubMed、EMBASE、CINAHL 和 Cochrane Library，检索时间截至 2020 年 9 月。检索词包括肌肉骨骼（MSK）疾病、物理治疗干预和临床预测规则。纳入了验证肌肉骨骼疾病物理治疗反应的规定性 CPR 的对照研究。两名独立评审员评估了合格性。确定了每个 CPR 的原始推导研究。使用 PROBAST 工具（推导研究）和 Cochrane 有效实践和组织护理组标准（验证研究）评估了偏倚风险。
有 9 项研究旨在验证 7 种针对 MSK 疾病（包括腰痛、颈痛、肩痛和腕管综合征）治疗反应的规定性 CPR。治疗包括手法治疗、牵引和运动。7 项研究未能证明 CPR 预测与结局之间存在关联。推导研究的方法学质量较差，验证研究的总体质量较好。
由于推导研究存在方法学缺陷，以及验证研究中 CPR 与结局之间缺乏关联，因此结果不支持使用任何已确定的 CPR 来辅助常见肌肉骨骼疾病的物理治疗选择。
