Week 11 Part 1 Flashcards
Prediction/Decision Rules and Practice Guidelines
Have the potential for great “real-world” value
Clinical Prediction Rule
the process of identifying a cluster of findings to assist clinicians in:
making a diagnosis
establishing a prognosis
selecting an optimum prescriptive intervention
CPRS have the ______ to improve decision making
potential
CPRS ____ decrease the need for more expensive intercessions
may
CPRS estimate the: _____ of a condition
diagnosis
clinical syndrome in lieu of anatomical gold standard
CPRS estimate the: _____ for the recovery of function
prognosis
CPRS estimate the _______ probability of a response to a particular intervention
Prescriptive
CPRs in physical therapy allow ?
us to classify a patient into a more homogenous subgroup based on the patient’s likely response to a specific treatment approach
The prediction/decision making rule for clinicians typically include three or more variables derived from the:
- history
- physical exam
- special tests
Step 1 Derivation
identification of factors with predictive power to develop the rule
Step 2 Validation
reproduction of the rule in a different setting and/or population of patients
step 3 Impact Analysis
evidence that the rule changes clinician behavior, reduces the cost of care, and improves patient outcomes
Sample size considerations
criticality, precision, and frequency
larger for cervical spine trauma x-ray necessity than need for spinal manipulation in LBP
the crticality
larger sample sizes will help narrow the CI which allows for a more _____ estimate of the probability
precise
prevalance of the condition
the frequency
the larger the prevalence or the likelihood of a desirable outcome
the smaller the number of subjects that need to be enrolled in the study
diagnostic
direct visulization, imaging
prognostic
defined level of function
intervention
reasonable standard of improvement
pain, function, influential impairment, patient satisfaction
sensitivity (SNOUT)
rules OUT condition
specificity (SPIN)
rules IN conditions
likelihood ratios
shifts in probability
Step regression
each variable is entered into the regression model and removed one at a time until the predictive power is compromised
less is better
A CPR should strive to have the fewest number of predictive indicators as possible without compromising the statistical accuracy
