Saturday, August 2, 2008

Are you CPR Certified?

ResearchBlogging.orgFortunately I'm not talking about through the Red Cross. As important as this life-saving skill is, it may be just as important to understand the nature of a more trendy form of CPR in the world of rehabilitation science: The Clinical Prediction Rule.

Prescriptive clinical prediction rules on topics such as lumbar manipulation, traction, and even anterior knee pain have emerged recently in our rehabilitation literature. The fact these reports exist underscore the fact that we are actively engaged in evolving into an evidence-based profession. However as has been recently and contentiously bantered on more than one discussion forum, as evidence builds it will become even more important for us to understand how to interpret and utilize this evidence in the most appropriate manner. In the case of such a potentially powerful tool as a CPR, we need to have a very clear understanding of its potential uses and possible pitfalls.

To this end, I would like to suggest two articles. The first is by Childs and Cleland published in our PT Journal in 2006. It provides excellent insight into the utility, establishment, and validation of a clinical prediction rule. The second article is actually an editorial in the Journal of Manual and Manipulative Therapy titled "The Potential Pitfalls of Clinical Prediction Rules". It is authored by Chad Cook, the editor-in-chief of JMMT, and provides a good overview of the potential misuses of a CPR.

Clinical prediction rules have been around for quite some time and have significant utility in a variety of clinical settings. They will no doubt be powerful allies in our quest for strengthening our clinical decision making. However, the most appropriate use of the CPR will occur with its judicious application and not blind allegiance. Whether we embrace it or not, the age of evidence-based medicine is upon us and is here to stay. Using evidence-based medicine with a clear understanding of what it truly is (and isn't!) will allow us to continue practicing the science of physical therapy without the trappings of becoming an automaton.

Instead of relying on my synopsis, I eagerly invite you to read these articles for yourself with the hope you will use them in the most appropriate manner for your patients. Enjoy!

Childs, J.D., Cleland, J. (2006). Development and Application of a Clinical Prediction Rule to Improve decision making in physical therapist practice. Physical Therapy, 86, 122-131.

Cook, C. (2008). Potential Pitfalls of Clinical Prediction Rules. Journal of Manual & Manipulative Therapy, 16(2), 69-71.