title: Validation and impact analysis of prognostic clinical prediction rules for low back pain is needed: a systematic review.
abstract: OBJECTIVE
  To identify prognostic forms of clinical prediction rules (CPRs) related to the nonsurgical management of adults with low back pain (LBP) and to evaluate their current stage of development.
  
  
  METHODS
  Systematic review using a sensitive search strategy across seven databases with hand searching and citation tracking.
  
  
  RESULTS
  A total of 10,005 records were screened for eligibility with 35 studies included in the review. The included studies report on the development of 30 prognostic LBP CPRs. Most of the identified CPRs are in their initial phase of development. Three CPRs were found to have undergone validation--the Cassandra rule for predicting long-term significant functional limitations and the five-item and two-item Flynn manipulation CPRs for predicting a favorable functional prognosis in patients being treated with lumbopelvic manipulation. No studies were identified that investigated whether the implementation of a CPR resulted in beneficial patient outcomes or improved resource efficiencies.
  
  
  CONCLUSIONS
  Most of the identified prognostic CPRs for LBP are in the initial phase of development and are consequently not recommended for direct application in clinical practice at this time. The body of evidence provides emergent confidence in the limited predictive performance of the Cassandra rule and the five-item Flynn manipulation CPR in comparable clinical settings and patient populations.
authors: School of Health Sciences, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia. Electronic address: Robin.Haskins@uon.edu.au.
authors: Robin
authors: R
authors: Haskins
authors: School of Health Sciences, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
authors: Peter G
authors: PG
authors: Osmotherly
authors: School of Health Sciences, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
authors: Darren A
authors: DA
authors: Rivett
mesh_terms: D000328:Adult; D016208:Databases, Factual; D003661:Decision Support Techniques; D006301:Health Services Needs and Demand; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D011379:Prognosis; D015203:Reproducibility of Results; D018434:Sickness Impact Profile
keywords: Clinical prediction rule; Decision support techniques; Derivation; Impact analysis; Low back pain; Prognosis; Systematic review; Validation