Evaluation of the usefulness of 2 prediction models of clinical prediction models in physical therapy: a qualitative process evaluation.

OBJECTIVE: The purposes of this study were to (1) evaluate the usefulness of 2 prediction models by assessing the actual use and advantages/disadvantages of application in daily clinical practice and (2) propose recommendations to enhance their implementation. METHODS: Physical therapists working in 283 practices in the area of Breda (the Netherlands) were invited to participate in this study. Two prediction models were presented: (1) to predict persistent shoulder pain and (2) to predict the preferable treatment in nonspecific neck pain. Participants were asked to apply both models in practice. After 2 months, their opinions about the usefulness of both models were gathered during a focus group meeting or by using an online questionnaire in order to identify the most important advantages/disadvantages of each prediction model. RESULTS: In total, 46 physical therapists (13.8%) of 39 practices participated. Evaluative data were available from 32 participants who used the shoulder model 102 times and the neck model 126 times. For the shoulder model, the most frequent advantage (mentioned 14 times) was that it enabled physical therapists to estimate a motivated prognosis, that is, a prognosis based on the score of the model. The most frequent mentioned disadvantage was that participants expressed their doubts about the validity of the model because the model initially was developed for usage in a general practice setting. For the neck model, the most frequently mentioned advantage (29 times) was that the model was easy to interpret. The most important disadvantage (mentioned 14 times) was that the model only takes a few treatment options into account. CONCLUSIONS: The physical therapists participating in this study reported that both models evaluated in this study were not easy to use in daily practice. Based on the findings of this study, we recommend that these models are modified to meet the practical needs of the therapist, before assessing their impact on daily clinical care and patient outcomes.

Preliminary state of development of prediction models for primary care physical therapy: a systematic review.

OBJECTIVE: To summarize the methodological quality and developmental stage of prediction models for musculoskeletal complaints that are relevant for physical therapists in primary care. STUDY DESIGN AND SETTING: A systematic literature search was carried out in the databases of Medline, Embase, and Cinahl. Studies on prediction models for musculoskeletal complaints that can be used by primary care physical therapists were included. Methodological quality of the studies was assessed and relevant study characteristics were extracted. RESULTS: The search retrieved 4,702 references of which 29 studies were included in this review. The study quality of the included studies showed substantial variation. The studied populations consisted mostly of back (n=10) and neck pain (n=6) patients, and patients with knee complaints (n=4). Most studies (n=22) used "perceived recovery" as primary outcome. Most prediction models (n=18) were at the derivation level of development. CONCLUSIONS: Many prediction models are available for a wide range of patient populations. The developmental stage of most models is preliminary and the study quality is often moderate. We do not recommend physiotherapist to use these models yet. All models reviewed here are in the developmental stage and need validation and impact evaluation before using them in daily practice.

The Brief IPQ does not have 'robust psychometrics': Why there is a need for further developmental work on the Brief IPQ, and why our study provides a useful start.

In this reply to Broadbent, Kaptein, and Petrie's commentary, we agree that our 'think aloud' study has limitations. However, we consider that the commentary goes too far in claiming these invalidate our findings. The authors of this commentary cite as a major limitation our use of a Dutch translation of the Brief IPQ. However, their reservations about this translation were not sufficient to prevent them from attempting to publish a paper describing the extended process behind its translation and validation. In contrast to the claims made, we consider that the Brief IPQ has poor concurrent validity, content validity is neglected, and no evidence is provided regarding discriminant validity. Our conclusions are described as 'overstated'-but we consider that calling into question the content validity of the Brief IPQ is fairly temperate, given the lack of attention it has received. Further, we cannot see how anyone could reasonably disagree with 'further developmental work with this questionnaire may be needed to better quantify and resolve the problems identified'-to do so it is to claim that the Brief IPQ is perfect! In sum, we think a more constructive response from the authors of this critique would be to engage with our observations, to improve the Brief IPQ.