Clinical Decision Support Tools for Selecting Interventions for Patients with Disabling Musculoskeletal Disorders: A Scoping Review.
Douglas P Gross, Susan Armijo-Olivo, William S Shaw and 7 others
PMID 26667939WHAT IT FOUND
No decision support tool for selecting interventions in musculoskeletal pain is ready for widespread use.
Most are early-stage questionnaires, algorithms, or prediction rules, with inconsistent testing and no confirmed patient benefit.
Key findings
01The review included 123 articles, mostly about low back pain (69 articles) and clinical prediction rules or classification systems (79 articles), and found 43 decision support tools.
02Only 8 articles discussed computer-based tools. The tools included 8 computer-based tools or questionnaires, 21 clinical prediction rules or classification systems, and 14 treatment algorithms or decision models.
03No tool is ready for widespread use. Evidence was mixed: four computer tools had positive preliminary results, one was ineffective, one thesis was negative, two studies were unclear, three studies tested development only, nine algorithms seemed positive, one algorithm study was negative, and four algorithm studies were untested.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This was a scoping review, so the authors did not judge the quality of the included studies. Many included studies were observational, exploratory, or based on secondary analyses, so they cannot show that a tool works. Most tools were tested in only a single setting or patient group. Only a few tools had been tested against patient outcomes such as recovery, disability, cost, or quality of life. The literature was dominated by low back pain, so it gives little information about neck, shoulder, knee, and other disorders. The review found no decision support systems for human resource managers or employer agents who develop return-to-work processes. The authors may have missed tools that were under development at the time.
Declared interests
The supplied funding section names the Workers' Compensation Board of Manitoba as funder.
The easy way to misread this
Do not read this as showing that decision support tools improve patient outcomes. The review found no tool ready for widespread use, and most evidence was early-stage or inconsistent.