Question
For what other areas or diagnoses have CPRs (Clinical Prediction Rules) been developed?
Answer
I can tell you about some of them. I was a co-author with Rob Wainner on two diagnostic CPRs. One was for Carpal Tunnel Syndrome; another for Cervical Radiculopathy. Most of them, unfortunately, have been focused in the orthopedic arena. The same methodology is absolutely generalizable to Clinical Prediction Rules, for example, in pediatrics, deciding which babies are the best candidates for helmets. I am hoping to see the emergence of those in the future.
As far as treatment related Clinical Prediction Rules, we have seen a host of them. There are some for determining which patients with ankle sprains are good candidates for getting mobilizations as a part of their rehab. Julie Whitman was a first author on that one. Josh Cleland has published several. Which patients with non-specific neck pain are going to benefit from manipulation to the thoracic spine, for example. There have been several in the area of manual therapy that we have seen. I have seen one published for determining which patients with neck pain are good candidates for cervical traction. We've seen some that determine, which patients with patellofemoral pain syndrome are candidates for treatment with off the shelf orthotics inserts in their shoes. So, there is a whole host of orthopedic conditions for which Treatment Clinical Prediction Rules have been developed. If you are not familiar with the Ottowa Rules, those are some of the first, and those have all been validated. They are very powerful rules for deciding. Like if you are in a primary setting where you see patients off of the street, there is the Ottowa Knee Rule that says that if there is a patient that has come in with any knee trauma, can you safely say to this patient that you do not need an x-ray? These have 100% sensitivity which means virtually no false negatives. You can confidently say to patients that if you meet this profile, you do not need an x-ray for your knee. There is a similar Ottowa Foot and Ankle Rule for people who have ankle and foot trauma to safely say who does and who does not need to be sent for an x-ray, radiograph or other imaging for the foot and ankle. And then there is the Canadian C-Spine Rule, for patients who have suffered whiplash injuries. When can you safely say it's safe for us to treat you without first getting any imaging to make sure that you didn't break your neck in that car accident. So these are very powerful tools.
