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Enthusiasm for prescriptive clinical prediction rules (eg, back pain and more): a quick word of caution
  1. Robin Haskins1,
  2. Chad Cook2
  1. 1 John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
  2. 2 Department of Physical Therapy, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Chad Cook, Department of Physical Therapy, Duke University, 2200 W Main St B230 Durham, NC 27705, USA; chad.cook{at}

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Prescriptive clinical prediction rules (CPRs) are commonly used in rehabilitation practice. Multiple systematic reviews have noted concern about the value of these rules and the violations of these tools. More recently, additional concerns have been outlined involving modelling errors, poor precision and fragility of the rules. This editorial outlines updated concerns about prescriptive clinical predication rules.

CPRs use baseline criteria called treatment effect modifiers,1 which are gathered from a physical examination to inform the type of treatment that a patient should preferentially receive. Many CPRs exist and have been enthusiastically incorporated in clinical practice. For example, CPRs exist to help identify which patients with back pain should receive spinal manipulation and stabilisation exercises. Their purpose is to better match patients to treatments, based on their predicted responsiveness to that treatment, independent of a diagnosis. Prescriptive CPRs are mentioned in clinical practice guidelines2 for patients with spinal pain and the premise …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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