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A Guide to Interpretation of Studies Investigating Subgroups of Responders to Physical Therapy Interventions
PHYS THER Hancock et al. 89: 698

Developing and Using Treatment-Based Clinical Prediction Rules

Participants: Julie Fritz, PT, PhD, ATC, Associate Professor, Department of Physical Therapy, University of Utah, and Clinical Outcomes Research Scientist, Intermountain Healthcare, Salt Lake City, Utah; Mark Hancock, PT, PhD, Lecturer, Back Pain Research Group, The University of Sydney, Sydney, New South Wales, Australia; Rob Herbert, PT, PhD, Senior Research Fellow, The George Institute for International Health, The University of Sydney. Moderator: Dan Riddle, PT, PhD, FAPTA, PTJ Deputy Editor in Chief.

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Literature about clinical prediction rules (CPRs) is growing exponentially, and it’s one of the hottest topics in physical therapy today. Fundamental differences of opinion exist regarding the optimal approach to identifying whether subgroups of more homogeneous patients respond to a specific type of intervention. What’s the current state of CPR development—and what does it all mean for practice and research? When it comes to day-to-day clinical decisions, how confident can you be about these data? In July 2009, PTJ published a Perspective titled "A Guide to Interpretation of Studies Investigating Subgroups of Responders to Physical Therapy Interventions" by Mark Hancock, Robert D. Herbert, and Christopher G. Maher. In this podcast, 2 of the authors debate the issues with Julie Fritz. As Fritz notes, “a big problem we all deal with is the amount of variability that there is in practice.” This podcast debate faces the hard questions head on.

Quotable quotes:

“We need to be able to very accurately identify the people who are the responders—otherwise, we’re not going to see any average worthwhile effect.” – Herbert
“The key distinction is between factors that relate to prognosis versus factors that really are effect modifiers.” – Fritz
“The tricky area is this idea of how we best identify hypothesis targets…. It’s incredibly important that researchers and clinicians work together on these projects.” – Hancock

Additional Selected References

Is there a subgroup of patients with low back pain likely to benefit from mechanical traction? Results of a randomized clinical trial and subgrouping analysis. Fritz JM, Lindsay W, Matheson JW, et al. Spine. 2007;15;32:E793-800.

Cleland JA, Childs JD, Fritz JM, et al. Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation, exercise, and patient education. Phys Ther. 2007;87:9-23.

Independent evaluation of a clinical prediction rule for spinal manipulative therapy: a randomised controlled trial. Hancock MJ, Maher CG, Latimer J, et al. Eur Spine J. 2008;17:936-943.

Can rate of recovery be predicted in patients with acute low back pain? Development of a clinical prediction rule. Hancock MJ, Maher CG, Latimer J, et al. Eur J Pain. 2009;13:51-55.

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This Article
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