Steven J. Rose PT, PhD, FAPTA said it well, “Our practice needs more research and…Our research needs more practice”.
This sums up nicely that clinical practice and research is a two-way street. Both are needed to progress the profession. I feel the literature is catching up to daily practice but is still lagging behind. Of course this can be argued if you’re on the research side of the profession. We see that most of the ‘things’ we do with patients aren’t backed up by EBP but it works time and time again! I guess you can call this the art of the science.
On the other hand, are clinicians using the current research in daily practice? I also do think clinicians get stuck in their ways and drag anchor.
What is an easy way to translate literature into daily practice? Clinical Prediction Rules.
Do I agree with them completely? Not always. Do these single-arm studies identify all responders? No. However, this is what we have available. It is to improve clinical decision making by adjusting the sensibility in performing a certain treatment in actual practice. It was initially used to help physicians interpret clinical information and in our case, to be evidenced-informed.
The following is an exam that I use to keep myself “objective” in objective.
With LBP with or without referring symptoms, I perform the following clinical tests with outcomes:
<—Diagnosis to Treatment—>
Van der Wurff 2006:
(+) 3/5 SIJ Pain Provocation tests CPR: Sens: 85, Spec: 79, LR+: 4.02, LR-: 0.19
ASIS Distraction/Compression, Thigh Thrust, FABER, Gaenslyn’s
(+) 2/4 SIJ Pain Provocation tests CPR: Sens: 88, Spec: 78, LR+: 4.00, LR-: 0.16
Thigh Thrust, ASIS Distraction & Compression, Sacral Thrust
Once I establish where the symptoms are arising from with the most accurate data available to date, the most appropriate intervention is chosen. Depending on the following variables that fit the patient, I usually prefer SMT.
Spinal Manipulation CPR (Flynn 2002)
1. Duration of symptoms < 16 days.
2. FABQ work subscale score < 19
3. At least one hip > 35 of IR ROM
4. Hypomobility of lumbar spine.
5. No symptoms below the knee.
4/5 predictors: LR+: 24.38. 95% probability of success.
3/5 predictors: LR+: 2.61. 68% probability of success.
Add these to your dictation software and you do not need to type or write them down everytime. It will make your evaluations more EBP’d, informative to the patient on their problem and solution, and best of all; quicker and smoother.
Do you use clinical prediction rules in your practice? If so, which ones and how do you incorporate it?
van der Wurff P, Buijs EJ, Groen GJ. A multitest regimen of pain provocation tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedures. Arch Phys Med Rehabil. 2006; 87(1): 10-14.
Laslett M, Aprill C, McDonald B, Young S. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther. 2005; 10:207-218.
Flynn T, Fritz J, Whitman J, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvements with spinal manipulation. Spine. 2002; 27: 2835-2843.