Potential Pitfalls of Clinical Prediction Rules

Is this editorial an attack on clinical prediction rules? Actually, it's quite the contrary. Prescriptive CPRs are useful tools for a select and discrete population of patients. As manually oriented clinicians, we have long realized that sub-sets of the population benefit from manual therapy more so than others. CPRs allow us to isolate a sub-set of desired patient characteristics and to define which techniques are most useful for that population. The current rehabilitation-based CPRs have opened the door for additional research to improve our accuracy as clinicians. Unfortunately, many of the present rehabilitation-based CPRs may have methodological weaknesses that may allow questioning of the utility of the instrument. Although there is no such thing as a “perfect” study, better and more rigorous designs should provide additional, profound and clinically applicable findings. As a clinician and a researcher, I am an advocate of CPRs.