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A Guide to Interpretation of Studies Investigating Subgroups of Responders to Physical Therapy Interventions

M. Hancock, PT, PhD, is Lecturer, Back Pain Research Group, The University of Sydney, Sydney, New South Wales, Australia. Mailing address: Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe 1825, New South Wales, Australia.
R.D. Herbert, PT, PhD, is Senior Research Fellow, The George Institute for International Health, The University of Sydney.
C.G. Maher, PT, PhD, is Director, The George Institute for International Health, The University of Sydney.

M.Hancock{at}usyd.edu.au

Many researchers and clinicians believe the effectiveness of existing physical therapy interventions can be improved by targeting the provision of specific interventions at patients who respond best to that treatment. Although this approach has the potential to improve outcomes for some patients, it needs to be implemented carefully because some methods used to identify subgroups can produce biased or misleading results. The aim of this article is to assist readers in assessing the validity and generalizability of studies designed to identify subgroups of responders to physical therapy interventions. The key messages are that subgroups should be identified using high-quality randomized controlled trials, the investigation should be limited to a relatively small number of potential subgroups for which there is a plausible rationale, subgroup effects should be investigated by formally analyzing statistical interactions, and findings of subgroups should be subject to external validation.

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