Comments on Guidelines and Clinical Prediction Rules

This short commentary by Dr. Jonathon Adler of Mass. General addresses several issues and concepts related to clinical practice guidelines and clinical prediction rules (the term clinical prediction "instruments" is now being used).

Although most of us have known about practice guidelines for some time, some may view clinical prediction rules (CPRs) as a recently new phenomenon.  And those who do little reading outside our field may view CPRs as being something primarily relgated to the field of physical therapy.  Not so on either account.  The New England Journal of Medicine discussed CPR methodology as early as 1985 and numerous examples of CPRs in the medical literature exist (streptoccol pharyngitis, febrile neutropenia to name a couple).  Although there are many issues and concerns related to clinical practice guidelines, I will say that CPRs have the potential to greatly improve clinical decision and reduce unwanted practice variation.

On a related note, congratulations to Dr. Josh Cleland and colleagues recently published a CPR for the identification of patients with neck pain who respond to thoracic manipulation, exercise, and patient instruction.   Also, congratulations to the Dr. Rebecca Craik and all the folks at PTJ for taking the journal to the next level.  The improved format and online intiatives are great, thank you!

 

Rob