Clinical Decision Support Tools for Selecting ... Decision... · Clinical decision support (CDS) is a term that has been used to define the myriad of ways in which knowledge is represented

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Journal of OccupationalRehabilitation ISSN 1053-0487 J Occup RehabilDOI 10.1007/s10926-015-9614-1

Clinical Decision Support Tools forSelecting Interventions for Patients withDisabling Musculoskeletal Disorders: AScoping Review

Douglas P. Gross, Susan Armijo-Olivo,William S. Shaw, Kelly Williams-Whitt,Nicola T. Shaw, Jan Hartvigsen, ZilingQin, et al.

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Clinical Decision Support Tools for Selecting Interventionsfor Patients with Disabling Musculoskeletal Disorders: A ScopingReview

Douglas P. Gross1 • Susan Armijo-Olivo2 • William S. Shaw3• Kelly Williams-Whitt4 •

Nicola T. Shaw5• Jan Hartvigsen6,7 • Ziling Qin2 • Christine Ha2 • Linda J. Woodhouse1 •

Ivan A. Steenstra8

� Springer Science+Business Media New York 2015

Abstract Purpose We aimed to identify and inventory

clinical decision support (CDS) tools for helping front-line

staff select interventions for patients with musculoskeletal

(MSK) disorders. Methods We used Arksey and O’Mal-

ley’s scoping review framework which progresses through

five stages: (1) identifying the research question; (2)

identifying relevant studies; (3) selecting studies for anal-

ysis; (4) charting the data; and (5) collating, summarizing

and reporting results. We considered computer-based, and

other available tools, such as algorithms, care pathways,

rules and models. Since this research crosses multiple

disciplines, we searched health care, computing science

and business databases. Results Our search resulted in 4605

manuscripts. Titles and abstracts were screened for rele-

vance. The reliability of the screening process was high

with an average percentage of agreement of 92.3 %. Of the

located articles, 123 were considered relevant. Within this

literature, there were 43 CDS tools located. These were

classified into 3 main areas: computer-based tools/ques-

tionnaires (n = 8, 19 %), treatment algorithms/models

(n = 14, 33 %), and clinical prediction rules/classification

systems (n = 21, 49 %). Each of these areas and the

associated evidence are described. The state of evidentiary

support for CDS tools is still preliminary and lacks external

validation, head-to-head comparisons, or evidence of gen-

eralizability across different populations and settings.

Conclusions CDS tools, especially those employing rapidly

advancing computer technologies, are under development

and of potential interest to health care providers, case

management organizations and funders of care. Based on

the results of this scoping review, we conclude that these

tools, models and systems should be subjected to further

validation before they can be recommended for large-scale

implementation for managing patients with MSK disorders.

Keywords Decision-making � Decision support

techniques � Musculoskeletal � Back pain � Return to work �Sick leave

Introduction

Regional musculoskeletal (MSK) disorders, such as back,

neck and shoulder pain, are some of the most common and

disabling health conditions internationally, leading to

substantial personal, social and economic burden [1, 2].

The high costs of disability and lost productive work time

associated with these conditions demand significant

& Douglas P. Gross

[email protected]

Ivan A. Steenstra

[email protected]

1 Department of Physical Therapy, University of Alberta,

2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada

2 Faculty of Rehabilitation Medicine, University of Alberta,

3-62 Corbett Hall, Edmonton, AB T6G 2G4, Canada

3 Liberty Mutual Research Institute for Safety, 71 Frankland

Road, Hopkinton, MA 01748, USA

4 University of Lethbridge, Calgary Campus, Suite S6032,

345 - 6th Avenue SE, Calgary, AB T2G 4V1, Canada

5 Algoma University, 1520 Queen Street East, CC 303,

Sault Ste. Marie, ON P2A 2G4, Canada

6 University of Southern Denmark, Odense, Denmark

7 Center for Muscle and Joint Health, Nordic Institute of

Chiropractic and Clinical Biomechanics, Campusvej 55,

5230 Odense M, Denmark

8 Institute for Work & Health, 481 University Avenue, Suite

800, Toronto, ON M5G 2E9, Canada

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improvements in health care strategies, especially in those

aimed at helping patients return to work. Systematic

reviews of health care interventions, such as physical

conditioning or pain management programs, targeted to

regional MSK disorders have indicated modest effective-

ness [3–6]. Furthermore, the response of individual patients

to these interventions is highly variable. Some patients

benefit greatly, while others do not improve, or even

experience a worsening of problems [7]. Improved meth-

ods for selecting the optimal interventions for individual

patients (i.e. personalized rehabilitation) would be

invaluable.

Clinical decision support (CDS) is a term that has been

used to define the myriad of ways in which knowledge is

represented in health information and/or management

systems to assist health care providers and other stake-

holders in patient management decisions [8]. CDS tools are

devices, instruments, questionnaires or other diverse

resources (including algorithms, continuums of care, and

treatment models) that present knowledge to health care

decision-makers, and are often designed as point-of-care

resources that support decisions regarding optimal treat-

ment choices. Research and development of CDS tools is a

rapidly growing field. These tools are attractive options,

given the widespread adoption of computer tablets and

smart phones. Also, CDS tools can be an efficient and time-

saving strategy for busy clinicians if treatment algorithms

are evidence-based and present minimal risks. This tech-

nology has the potential to augment complex decisions

such as those performed for regional MSK disorders.

Computerized CDS has the potential to significantly

improve human decisions by expediting information

retrieval, identifying unique patient needs, triaging care,

and matching patients to the most appropriate resources

and treatments.

Some promising CDS tools have been developed

specifically for use with patients that have regional pain

disorders [9–11]. However, the effectiveness, utility and

feasibility of CDS resources in the treatment of regional

MSK disorders has been under investigated [12]. Previous

systematic reviews of CDS tools have focused on the

evaluation of medical management and included only

randomized controlled trials from the health care literature

[12–17]. However, CDS for the treatment of patients with

regional MSK disorders is an emerging area that covers

multiple disciplines (including health care, computing

science, occupational health services and human resource

management). The current literature is therefore diverse

and fragmented [11, 18, 19] using inconsistent terminolo-

gies and methods. However, to date, no thorough synthesis

and summary of these methods is available. In addition, the

state of the science in terms of effectiveness, utility, and

feasibility of CDS resources in the treatment of MSK

disorders has not been summarized as a whole. Given the

diversity of the literature and emerging nature of the field, a

comprehensive scoping review is needed to map the sci-

entific and grey literature on this topic [20].

The purpose of this project was therefore to conduct a

scoping review of CDS tools designed to help decision-

makers select interventions that are specifically intended to

improve function and return to work in patients with pain-

related MSK disorders. This review was also open to other

patient related outcomes such as pain, and disability. Our

study aims were to identify and inventory CDS tools for

helping front-line staff select interventions. We considered

both computer-based CDS and other available tools such as

treatment algorithms, care pathways, prediction rules, and

models. In addition, we aimed to summarize key concepts

and terminology to provide criteria for future reporting,

evaluate and synthesize evidence of the effectiveness and

utility of the available tools, and recommend directions for

future research and development in this area.

Methods

Design

This study was a scoping review, which is a methodology

for rigorously collecting, synthesizing, appraising and

presenting findings from existing research on a topic [20–

22]. This approach is especially relevant when an area is

emerging or diverse because it examines the extent, range

and nature of the research activity [23]. Generally scoping

reviews are referred to as ‘a mapping process’ since they

summarize a range of evidence in order to convey the

breadth and depth of a field [24]. Unlike systematic

reviews, scoping reviews do not require appraisal of the

quality of the included studies. However, the scoping

process requires an analytical interpretation and inventory

of the available literature. A scoping review is also useful

for determining whether enough literature is available on a

topic to conduct a formal systematic review or a meta-

analysis or to identify gaps in the literature. In addition,

scoping reviews can include a range of study designs and

address complex and diverse questions that cannot typi-

cally be addressed with a systematic review. Our research

area is both emerging and diverse. For these reasons, we

chose to conduct a scoping review.

We adopted the scoping review framework proposed by

Arksey and O’Malley [23]. This framework progresses

through five stages: (1) identifying the research question;

(2) identifying relevant studies; (3) selecting studies for

analysis; (4) charting the data; and (5) collating, summa-

rizing and reporting results. Each stage will be discussed in

detail below.

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Identifying the Research Question

An iterative process was used in which we reflexively

adapted our question, search terms, and strategy to ensure

comprehensive coverage of the literature [23]. An initial

question provided the scope for the review and contained

several key concepts that guided the search terms used.

However, the question was refined based on the broad

spectrum of articles we obtained in the initial search. Ini-

tially we had included CDS tools for selecting interven-

tions as well as making diagnoses and prognoses. However,

due to the extensive breadth of the literature obtained and

impracticality of reviewing all 3 research domains, we

decided to focus on intervention tools only. This decision

was made after consultation with all the researchers and

knowledge users involved.

Our final research question was the following: ‘‘Do

validated decision support tools (especially computer-

based tools) exist for selecting appropriate interventions for

improving function and return to work in patients with

pain-related MSK disorders?’’

Identifying Relevant Studies

Relevant studies were identified through online searches of

health care, computing science and management databases.

These searches were performed with the assistance of two

experienced research librarians at the University of Alberta

who had access to, and a thorough knowledge of all the

necessary databases and search engines. Databases sear-

ched included Ovid MEDLINE, Ovid EMBASE, Scopus,

CINAHL, Business Source Complete, ABI/INFORM

Global, Social Science Research Network (SSRN), Web of

Science, ACM Digital Library, IEEE Xplore, ACM Com-

puting Reviews, Computing Research Repository (CoRR),

NECI ResearchIndex (formerly CiteSeer) and Google

Scholar. Our search strategies were adapted to the various

databases as required with the assistance of the librarians.

The search included all articles in all languages since the

inception of the databases.

Keywords included musculoskeletal diseases; muscu-

loskeletal disorders; back pain; neck pain; shoulder pain;

disability evaluation; vocational rehabilitation; return to

work; decision support techniques; decision support tools;

decision making; clinical protocols; computer-assisted. An

example of a search strategy performed in Medline is

presented in ‘‘Appendix 1’’.

Grey literature (unpublished documents from outside the

peer-reviewed scientific literature) were also searched. We

applied the Canadian Agency for Drugs and Technologies

in Health’s Grey Matters search tool to search for relevant

information and websites [25]. In addition, Google was

searched to identify possible unpublished studies. Relevant

articles from the study teams’ own research or libraries

were also included.

Each CDS tool located was tracked in the Scopus

database and Google Scholar to determine whether addi-

tional studies investigating the tool had been published.

Selecting Studies for Analysis

The following were the final set of inclusion/exclusion

criteria for the review:

Topic of the article A CDS tool for selecting

interventions.

Population Patients with any painful MSK disorder (e.g.,

regional pain disorders of the back, neck, knee, shoulder,

etc.). Our review included all MSK conditions available

in the literature and all terms referring to MSK

conditions were included in the searches. We excluded

articles on non-MSK disorders including metabolic/

endocrine disorders (i.e. osteoporosis, diabetic ulcers),

rheumatic disorders (i.e. ankylosing spondylitis, rheuma-

toid arthritis, fibromyalgia) and other general medical

conditions.

Outcome Functional and work-related outcomes, includ-

ing return to work, disability, performance, and absen-

teeism. Functional recovery is a crucial outcome in

regional pain disorders. From the perspective of the

various stakeholders involved (i.e. workers, insurers,

employers and health care providers), recovery from

pain is important; however, functional recovery—such

that the patient can return to work and participate in

normal daily living—is equally important and has

important career and quality-of-life implications [26,

27]. Functional recovery is also often easier to measure.

For these reasons, we focused primarily on interventions

aimed at improving function or facilitating return to

work and other activities of daily living.

Study type Any design describing or evaluating a CDS

tool. Systematic reviews were excluded but references

within those located were searched for further articles.

The titles and abstracts of articles obtained from the

online databases were reviewed and appraised for rele-

vance. Two independent researchers from the team read

each title/abstract and judged whether they were relevant to

the research question. When there were disagreements

between reviewers, the principal researcher (DPG) offered

additional consultation until a decision could be reached. If

the relevance of a study was still unclear, then the full

article was obtained. After selecting the relevant abstracts

and titles, two independent researchers assessed the cor-

responding full versions of the studies to determine which

articles should be included in the full review. If discipline-

specific questions arose, the reviewers consulted with the

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team member with relevant expertise (i.e. computers,

health care, human resource management, etc.) who could

answer the question. We used a Microsoft Access (Red-

mond, Washington) database stored on an internal server at

the University of Alberta that was securely accessible by

team members for all stages of the review.

Consultation with Knowledge Users

The consultation process for this study incorporated the

development of an advisory committee that included

knowledge users who were representatives of local reha-

bilitation clinics in the Edmonton area, national networks

of health care clinics that provide rehabilitation to injured

workers, and experienced compensation case managers.

We held meetings with knowledge users at two key stages

of the review: selecting studies for analysis, and summa-

rizing and reporting results. Knowledge users were asked

whether they knew of any CDS tools currently in use or

relevant articles. Feedback from knowledge users during

these consultative meetings highlighted the importance of:

(1) including functional and return-to-work outcomes as

search terms; (2) considering not only papers describing

specific CDS tools, but also theoretical or conceptual

papers dealing with models or algorithms describing

treatment selection approaches for patients with MSK

disorders; (3) having reviewers consider workplace-based

interventions (i.e. accommodations, modifications, etc.)

and work-related outcomes (i.e. productivity, absenteeism,

etc.) during abstract and title screening; and lastly, (4)

considering the importance of feasibility, time of tool

administration, cost, and ease of interpretation in addition

to scientific validation when considering the utility of any

CDS tools located. Before charting the data, the knowledge

users were consulted to determine whether the number of

articles selected was appropriate and whether the search

terms should be altered.

Data Analysis

Charting the Data

Reviewers extracted relevant information from the articles

and entered it into an electronic data chart created with the

Microsoft Access program. This form included data for

authors, year of publication, article title, discipline of the

lead authors, geographic location of the study, type and

brief description of the CDS tool (including a list of factors

included in the tool’s algorithm such as age, sex, pain level,

etc.), cost of the tool, study population, study design and

goals, methods used, outcome measures used, important

results and any economic data recorded. For computer-

based tools, we extracted additional information using

categories taken from a previously published CDS taxon-

omy [28]. These charting methods provided a standard and

systematic approach to summarize the papers and extract

all relevant information.

Collating, Summarizing and Reporting Results

During this stage, we created an overview of all research

located. Initially, we presented a basic numerical summary

of the studies, including the extent, nature and distribution

of the articles. Then, we summarized articles according to

the types of tools described or evaluated, research methods

used, populations studied, and study results/outcomes.

As mentioned earlier, the scoping review methodology

was intended to summarize both the breadth and depth of

the literature. We reported the number of articles for each

CDS tool as well as some descriptive information about the

articles. Since this was a scoping review, we did not

undertake a critical appraisal of quality. However, we

attempted to map the diversity observed and inventory the

various study designs and methods used. This procedure

allowed us to draw conclusions about the nature of research

in this area and provide recommendations for future studies.

Several clinical prediction rules were designed to iden-

tify those individuals likely to respond positively to a

particular treatment or intervention. These types of tools

have been summarized in other reviews [29, 30], but we

created an updated table to establish the range of tools in

this category and to examine the strengths and limitations

of these rules.

The various CDS tools identified in the articles were

also categorized, and key concepts and terminology used in

the articles were summarized in tables.

Guidelines developed by Terwee et al. [31] were used to

define quality of measurement properties of the CDS tools.

Briefly, quality of measurement included internal (internal

consistency, relevance of items and representativeness of

items of the scale-content validity) as well as external

components of validity (the relationship with other tests in

a manner that is consistent with theoretically derived

hypotheses-construct validity). Intra and inter-rater relia-

bility (i.e. repeatability of measurements taken by the same

tester at different times and repeatability of measurements

taken by different testers, respectively) were also consid-

ered. Definitions of psychometric properties for this review

are provided in ‘‘Appendix 2’’.

Results

The initial search considering all online databases identi-

fied 4605 potentially relevant articles. From these, 189

unique studies were included for the second stage;

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screening full texts. After screening full texts, 133 articles

were selected. From these, 34 articles were removed since

they were systematic reviews or considered irrelevant for

the purposes of the study. However, their references were

searched. From the reference search of these studies and

stakeholder meetings, we obtained 24 additional articles.

Thus, 123 studies were included for data extraction. The

reliability of the screening process of titles and abstracts

was high with an average agreement percentage of 92.3 %

between reviewers. Figure 1 shows the flow chart of our

article search and relevance selection process. A search of

the grey literature obtained no new documents or websites

specific to MSK disorders.

General Description of Articles

Of the 123 relevant articles located, most originated in

North America (n = 70, 57 %), were published between

2006 and 2014 (n = 101, 82 %), and discussed a clinical

prediction rule or a classification system (n = 79, 64 %).

Twenty-one articles (17 %) discussed treatment algorithms

or models, 15 (12 %) discussed questionnaires, while only

8 (7 %) discussed computer-based tools. Most of the arti-

cles pertained to low back pain (n = 69, 56 %), followed

by neck, shoulder or arm pain (n = 21, 17 %), and general

MSK disorders (n = 17, 14 %). When the article described

an original study (n = 75), designs of these studies varied

greatly from randomized controlled trials (RCTs) to case

series and reports. The majority of the original studies were

observational in nature, most commonly cohort studies

(n = 31, 41 %). Table 1 displays more details about the

characteristics of located studies.

Overall, there were 43 CDS tools located. After

reviewing the tools and identified articles, these were

classified into three main areas: (1) specific computer-

based tools or questionnaires (n = 8, 19 %); (2) clinical

prediction rules/classification systems aimed at categoriz-

ing patients into various treatment groups (n = 21, 49 %);

and (3) theoretical or algorithmic approaches to selecting

treatments (treatment algorithms/models) (n = 14, 33 %).

Each of these areas and the tools located will be described.

Computer-Based Tools/Questionnaires

Table 2 provides an inventory of the 8 computer-based

devices or questionnaires located for selecting interven-

tions for patients with pain-related MSK disorders. Table 3

provides a summary of the original studies evaluating these

tools. Twenty-two manuscripts including three theses [32–

53] looked at these 8 tools. Three questionnaire-based tools

were included: Keele STarT Back Screening Tool (SBST),

the Pain Recovery Inventory of Concerns and Expectations

(PRICE) questionnaire, and the Orebro Musculoskeletal

Pain Questionnaire (OMPQ). We also located 5 tools

incorporating computer technology: Repetitive Strain

Injury (RSI) QuickScan intervention program, the Pain

Management Advisor (PMA), the Decision Support System

(DSS) for helping ergonomists better match workers with

the work environment, the Soft Tissue Injury Continuum of

Care Model with computerized prompts for case managers,

and the Work Assessment Triage Tool (WATT). Three of

4,605 Articles Located in Literature Search

189 Identified as Potentiall Relevant

133 Selected From Second Screening

4416 Deemed Irrelevant in Title/Abstract

56 Deemed Irrelevant in Full Text Screening

123 Final Articles for Data Extraction

34 Systematic Reviews and Irrelevant Articles Removed but References Searched

17 Articles Deemed Relevant from Reference Search and 7 Articles from the Authors’ Personal Collections

y

Fig. 1 Flow chart of article

search and relevance selection

process

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these tools were aimed at workers with low back pain

(SBST, PRICE and OMPQ), 2 were aimed at work-related

upper extremity disorders (RSI QuickScan and DSS), 2

were aimed at general work-related MSK injuries (WATT

and Soft Tissue Continuum of Care), and 1 aimed at

assisting physicians in managing patients with chronic pain

(PMA).

Most of these tools had some psychometric testing in the

way of validation of items, concurrent validity, accept-

ability of the tool, accuracy of the classification as well as

testing the effectiveness of the tool compared to standard

treatment. Nevertheless, this testing has been preliminary,

and a more exhaustive validation process involving ran-

domized controlled trials at multiple sites and settings is

needed for all of the tools. Four of the tools [34, 35, 37, 38]

showed positive preliminary results regarding the use of

the tool to determine appropriate treatments for managing

some MSK conditions. However, one tool (RSI Quick-

Scan) did not prove to be effective for reducing work

disability or cost-effective [40, 52], and two studies did not

have clear positive or negative results regarding the tools

evaluated (SBST and WATT) [33, 42]. One student thesis

evaluated the utility of the OMPQ as a clinical decision

support tool for workers’ compensation claimants, with

negative results [39]. However, the OMPQ was initially

developed as a screening or prognostic tool, not explicitly

as a CDS tool. In addition, one protocol of a cluster RCT

that attempts to use the OMPQ as a CDS tool for selecting

interventions for patients with LBP was found [44]. The

results of this RCT are still unpublished, so it is unknown

how well the OMPQ functions as a CDS tool. Three other

studies [32, 36, 41] only looked at the development phase

of the tools (WATT and PRICE). Thus, evidence is limited

regarding validity evidence of these CDS tools. For details

of the measurement properties of the CDS tools found, see

Table 4.

Treatment Algorithms/Decision-Models

Of the 22 articles [54–75] discussing treatment algo-

rithms/models, there were 15 original studies evaluating 14

different algorithms or decision-models (theoretical or

empirical) for selecting interventions for patients with

MSK disorders. Details of these algorithms/models and the

studies can be found in Table 5. Nine of the studies [54–61,

76] looked at low back pain, 2 discussed knee disorders

[62, 63], 2 discussed shoulder disorders [64, 65] and 2

examined other body regions (wrist and neck) [66, 67].

Research designs used in these studies varied greatly, with

the observational cohort study being the most common

among them. Methodologies and types of algorithms were

also wide-ranging, making the analysis of these studies

Table 1 Descriptive characteristics of included articles (n = 123)

Number (%)

Source of evidence

Peer-review journal article 75 (61)

Commentary/editorial/article summary 19 (15)

Conference proceeding 9 (7)

Review 9 (7)

Study protocol 6 (5)

Thesis 5 (4)

Discipline of lead authors

Health care 121 (98)

Computing science 2 (2)

Geographic location of lead authors

North America 70 (57)

Europe 21 (17)

Australasia 9 (7)

Asia 4 (3)

Multiple locations 19 (15)

Year of publication

2006–2014 101 (82)

2000–2005 18 (15)

Before 2000 4 (3)

Type of tool discussed in the article

Clinical prediction rule/classification system 79 (64)

Questionnaire 15 (12)

Treatment algorithm 15 (12)

Theoretical/empirical model 6 (5)

Computer-based tool 8 (7)

Condition aimed at by tool

Low back pain 69 (56)

Neck/shoulder/arm pain 21 (17)

General MSK disorders 17 (14)

Knee/ankle pain 6 (5)

Upper extremity pain 3 (2)

Serious pathology (fractures, etc.) 5 (4)

Thoracolumbar injury 2 (2)

Reasoning method

Rule-based 109 (89)

Other (e.g., neural network, decision tree) 8 (7)

Unclear 6 (5)

Study design of peer-review studies located (n = 75)

Experimental

Randomized controlled trial 12 (16)

Quasi-experimental 4 (5)

Observational

Cohort study 31 (41)

Case control/case report/case series 15 (20)

Cross-sectional study 6 (8)

Secondary analysis 5 (7)

Methodological study 2 (3)

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se

signifi

cantl

yfr

om

the

SB

ST

low

risk

gro

up,

over

the

med

ium

gro

up

toth

ehig

h-r

isk

gro

up

[165

]

Fai

rag

reem

ent

bet

wee

nS

BS

Tto

ol

(K=

0.2

2)

and

clin

icia

ns

clas

sifi

cati

on

of

pat

ients

into

risk

gro

ups

[33

]

Sta

rTB

ack

Tool

has

bee

n

tran

slat

edan

dcr

oss

cult

ura

lly

val

idat

edin

toD

anis

h[1

66

],

Span

ish

[167

],F

rench

[168

],

Ger

man

[155

],S

wed

ish

[163

],

Chin

ese

[156

],an

dF

innis

h[1

69

]

The

test

–re

test

reli

abil

ity

of

the

SB

ST

tota

lsc

ore

was

exce

llen

t

(intr

acla

ssco

rrel

atio

n

coef

fici

ent=

0.7

8;

[169

]0.9

3

[156

];an

d0.9

0[1

64

])an

dgood

for

the

psy

choso

cial

subsc

ale

(0.6

8)

[169

]

The

Sta

rTB

ack

Tool

dem

onst

rate

d

acce

pta

ble

toouts

tandin

g

dis

crim

inat

ion

todet

erm

ine

indiv

idual

sw

ith

dif

fere

nt

level

s

of

dis

abil

ity

asin

dic

ated

by

wid

ely

acce

pte

dques

tionnai

res

such

asth

eR

ola

nd

Morr

is

Dis

abil

ity

Ques

tionnai

re,

Tam

pa

Sca

leof

Kin

esio

phobia

among

Not

nee

ded

9ques

tions

are

answ

ered

wit

h

aL

iker

t-sc

ale

regar

din

gpai

n

and

acti

vit

ies

of

dai

lyli

vin

g.

The

tool

has

bee

ntr

ansl

ated

into

sever

al

languag

es

Tre

atm

ents

reco

mm

endat

ions

bas

edon

risk

cate

gori

es:

low

,

med

ium

or

hig

hri

sk.

The

auth

ors

sugges

t

that

the

low

risk

gro

up

only

nee

ds

a‘l

ight’

inte

rven

tion

wit

he.

g.,

anal

ges

ics

and

advic

e,

the

med

ium

gro

up

requir

estr

eatm

ents

involv

ing

elem

ents

such

asex

erci

ses

or

man

ual

ther

apy,

and

that

aco

mbin

atio

nof

physi

cal

and

cognit

ive-

beh

avio

ral

appro

aches

should

be

consi

der

edfo

rth

e

hig

hri

skgro

ups

Pri

mar

yca

re

pro

vid

ers

The

tool

has

not

bee

nval

idat

edvia

clin

ical

tria

l

outs

ide

the

Unit

ed

Kin

gdom

Ther

eis

also

anee

d

for

ala

rge

RC

T

des

igned

tote

st

whet

her

trea

tmen

t

effe

cts

dif

fer

acro

ssth

eS

BS

T

subgro

ups

J Occup Rehabil

123

Author's personal copy

Page 10

Table

2co

nti

nu

ed

Nam

eof

CD

SS

Purp

ose

Des

crip

tion

Sta

ge

of

Dev

elopm

ent

Har

dw

are

and

Soft

war

e

Dat

aIn

put

Req

uir

emen

ts

Outp

ut(

s)T

arget

Rec

ipie

nt

of

Outp

ut

Lim

itat

ions

oth

ers

(AU

Cra

nged

from

0.7

9to

0.9

1[1

55

],an

d0.7

5–0.8

9[1

56

]

Rep

etit

ive

Str

ain

Inju

ry(R

SI)

Quic

kS

can,

Now

nam

ed

‘Com

pufi

tQ

uic

k

Sca

n’

[40

,52

]

To

asse

ssth

e

pre

sence

or

abse

nce

of

pote

nti

alri

sk

fact

ors

for

the

esta

bli

shm

ent

of

risk

pro

file

s

rela

ted

tonec

k,

should

eran

d

arm

sym

pto

ms

inco

mpute

r

work

ers

and

pote

nti

ally

det

erm

ine

targ

eted

trea

tmen

t

Com

pute

r-bas

ed

surv

eyai

med

at

iden

tify

ing

work

ers’

atri

skof

arm

,sh

ould

eran

d

nec

ksy

mpto

ms.

Bas

edon

score

resu

lts,

reco

mm

endat

ions

are

mad

eto

the

work

erto

reduce

risk

of

sym

pto

ms.

Into

tal,

the

ques

tionnai

re

consi

sts

of

81

item

s,div

ided

over

two

cate

gori

esan

d

11

subca

tegori

es.

Ades

crip

tion

of

the

actu

al

ques

tions

can

be

found

at:

ww

w.

com

pufi

tquic

ksc

an.

com

/ne/

quic

ksc

an/

The

tool

has

bee

nte

sted

ina

clust

er

random

ized

contr

ol

tria

lan

d

asso

ciat

edco

st-e

ffec

tiven

ess

eval

uat

ion.U

seof

the

tool

did

not

reduce

work

dis

abil

ity

and

the

tool

was

not

found

tobe

cost

-

effe

ctiv

e

The

tool

does

hav

e

acce

pta

ble

inte

rnal

consi

sten

cy,

reli

abil

ity

and

concu

rren

t

val

idit

y.

Cro

nbac

h’s

alpha

was

most

lybet

wee

n0.4

0an

d0.8

5.

Six

scal

essc

ore

d0.7

0or

hig

her

.

Concu

rren

tval

idit

yof

the

RS

I

wit

hori

gin

alques

tionnai

res

was

acce

pta

ble

[170

]

The

concu

rren

tval

idit

yof

the

ques

tionnai

resy

mpto

mit

ems

wit

hth

eobse

rvat

ions

of

2

physi

cian

sw

asdefi

ned

aspoor

to

moder

ate

wit

hkap

pa

val

ues

bet

wee

n0.1

6an

d0.5

3[1

71

]

Pre

dic

tive

Val

idit

yof

the

RS

I

Quic

kS

can

ques

tionnai

rew

as

test

ed.

Hig

hsc

ore

sof

the

RS

I

Quic

kS

can

on

9out

of

13

scal

es,

incl

udin

gpre

vio

us

sym

pto

ms,

wer

esi

gnifi

cantl

yre

late

dto

arm

,

should

eran

dnec

ksy

mpto

ms

at

foll

ow

-up

[172

]

Inte

rnet

-bas

edR

SI

Quic

kS

can

surv

ey/

ques

tionnai

re

(htt

ps:

//w

ww

.

com

pufi

tquic

ksc

an.

com

/ne/

quic

ksc

an)

Item

sar

e

answ

ered

foll

ow

ing

a

web

pla

tform

Inte

rven

tions

can

be

targ

eted

atea

chof

the

fact

ors

inth

eR

SI

Quic

kS

can,

wit

ha

tota

lof

16

inte

rven

tions

aim

edat

reduci

ng

the

asso

ciat

edri

sk[3

6,

52].

Asc

ore

of

30

%

or

less

of

the

max

imum

on

asc

ale

was

clas

sifi

edas

alo

w

risk

,co

lour-

coded

‘‘gre

en’’

.A

score

of

31

%to

60

%of

the

max

imum

on

asc

ale

was

clas

sifi

edas

a

med

ium

risk

,co

lour-

coded

‘‘am

ber

’’.

A

score

of

61

%or

more

of

the

max

imum

on

a

scal

ew

ascl

assi

fied

as

ahig

hri

sk,

colo

ur-

coded

‘‘re

d’’

.

Pri

mar

yca

re

pro

vid

ers

and

ergonom

ists

The

RS

IQ

uic

kS

can

appea

rsto

hav

ea

modes

tef

fect

and

was

not

cost

-

effe

ctiv

e.

How

ever

,th

is

mig

ht

hav

ebee

n

due

topro

ble

ms

wit

h

imple

men

tati

on

of

expen

sive

ergonom

ic

inte

rven

tions,

whic

hw

ere

sold

at

regula

r

com

mer

cial

pri

ces

duri

ng

the

tria

l.

This

was

des

pit

e

com

mit

men

tfr

om

all

par

tici

pat

ing

org

aniz

atio

ns

pri

or

tost

arti

ng

the

study

that

they

wer

epre

par

edto

inves

tin

the

nec

essa

ry

pre

ven

tive

mea

sure

s

Pai

nR

ecover

y

Inven

tory

of

Conce

rns

and

Expec

tati

ons

(PR

ICE

)[3

6]

Bri

efsc

reen

ing

ques

tionnai

reto

tria

ge

retu

rn-t

o-

work

stra

tegie

s

among

pat

ients

wit

hlo

wbac

k

pai

n

Ques

tionnai

re

consi

stin

gof

46

item

sm

easu

ring,

dep

ress

ive

sym

pto

ms

(12

item

s),

pai

n

cata

stro

phiz

ing

(2

item

s),

lack

of

org

aniz

atio

nal

support

(7it

ems)

,

acti

vit

yli

mit

atio

n

(15

item

s),

fear

of

movem

ent

(4

item

s),

per

ceiv

ing

gra

ve

life

impac

ts

(3it

ems)

poor

expec

tati

ons

for

Aco

nfi

rmat

ory

clust

eran

alysi

s

repli

cate

dpre

vio

us

findin

gs

of

thre

eri

sksu

bgro

ups:

dis

tres

sed,

avoid

ant,

and

lack

ing

emplo

yer

support

Val

idit

yof

the

PR

ICE

scre

enin

g

was

support

edby

its

pro

spec

tive

asso

ciat

ion

wit

hth

e3-m

onth

dis

abil

ity

outc

om

em

easu

res

(ret

urn

tow

ork

,fu

nct

ional

lim

itat

ion,

and

clin

ical

case

rati

ng)

[36

]

Not

nee

ded

Subje

cts

are

asked

to

resp

ond

to

each

of

the

46

item

son

dif

fere

nt

Lik

ert-

type

scal

essc

ale

(i.e

.‘‘

stro

ngly

dis

agre

e’’

to

‘‘st

rongly

agre

e.’’

;‘‘

not

atal

l’’

to‘‘

all

the

tim

e’’)

PR

ICE

can

be

use

dto

iden

tify

earl

y

inte

rven

tion

nee

ds

among

work

ing

adult

s

wit

hlo

wbac

kpai

n

bas

edon

the

gro

up

clas

sifi

cati

ons

Itpro

vid

esan

indic

atio

n

of

whet

her

atte

nti

on

should

be

focu

sed

on

work

pla

ce

coord

inat

ion,

physi

cal

acti

vat

ion,

or

psy

cholo

gic

alco

pin

g,

and

this

may

impro

ve

the

abil

ity

topro

vid

e

Pri

mar

yca

re

pro

vid

ers

This

ques

tionnai

reis

atan

earl

yst

age

of

dev

elopm

ent.

Futu

retr

ials

should

be

conduct

edto

val

idat

eth

e

clas

sifi

cati

on

and

targ

eted

man

agem

ent

appro

ach

J Occup Rehabil

123

Author's personal copy

Page 11

Table

2co

nti

nu

ed

Nam

eof

CD

SS

Purp

ose

Des

crip

tion

Sta

ge

of

Dev

elopm

ent

Har

dw

are

and

Soft

war

e

Dat

aIn

put

Req

uir

emen

ts

Outp

ut(

s)T

arget

Rec

ipie

nt

of

Outp

ut

Lim

itat

ions

reco

ver

y(2

item

s),

and

pai

nin

tensi

ty

(1it

em)

[36

]

more

pat

ient-

cente

red

stra

tegie

sfo

rea

rly

dis

abil

ity

pre

ven

tion

Ore

bro

Musc

ulo

skel

etal

Pai

n

Ques

tionnai

re

(OM

PQ

)[3

9]

Scr

eenin

gto

ol

aim

edat

iden

tify

ing

hig

h-

risk

pat

ients

wit

hM

SK

pai

n

innee

dof

earl

y

inte

rven

tion

Ques

tionnai

re

consi

stin

gof

24-i

tem

sth

at

allo

cate

spat

ients

into

thre

edif

fere

nt

risk

cate

gori

es

rela

ted

tow

ork

abse

nte

eism

and

guid

espote

nti

al

inte

rven

tions

for

those

wit

hlo

w

(rea

ssura

nce

and

advic

e),

moder

ate

(physi

cal

ther

apy)

or

hig

hri

sk

(psy

cholo

gic

ally

-

info

rmed

care

)

The

OM

PQ

was

init

iall

ydev

eloped

asa

scre

enin

gto

ol

and

has

bee

n

eval

uat

edin

sever

alse

ttin

gs

and

tran

slat

edin

tose

ver

alla

nguag

es

for

this

purp

ose

.H

ow

ever

,it

has

rece

ntl

ybee

nev

aluat

edas

a

pote

nti

alC

DS

tool

for

sele

ctin

g

inte

rven

tions

for

pat

ients

wit

h

MS

Kpai

n.

One

study

is

under

way

inG

erm

any

that

eval

uat

esth

eO

MP

Qas

aC

DS

tool

[44

]

Not

nee

ded

24

item

sw

ith

var

ious

resp

onse

opti

ons

for

dif

fere

nt

sect

ions

of

the

tool

Aft

erO

MP

Q

adm

inis

trat

ion

and

scori

ng,

the

ques

tionnai

re

cate

gori

zed

pat

ients

into

one

of

thre

eri

sk

level

cate

gori

es:

low

,

med

ium

and

hig

hri

sk.

Var

ious

cut-

poin

ts

hav

ebee

n

reco

mm

ended

for

the

cate

gori

zati

on,

wit

h

the

dev

eloper

sst

atin

g

the

cut-

off

score

sar

e

rela

ted

toth

e

popula

tion

studie

d

Pri

mar

yca

re

pro

vid

ers

Has

only

bee

n

eval

uat

edas

a

CD

Sto

ol

inone

studen

tth

esis

,w

ith

neg

ativ

ere

sult

s.

The

OM

PQ

was

not

expli

citl

y

dev

eloped

asa

CD

Sto

ol,

alth

ough

earl

yri

sk

stra

tifi

cati

on

impli

esdif

fere

nt

appro

aches

for

dif

fere

nt

cate

gori

es

Pai

nM

anag

emen

t

Advis

or

(PM

A)

[35

]

To

enhan

ce

pri

mar

yca

re

pro

vid

ers’

man

agem

ent

of

chro

nic

pai

n

Com

pute

r-bas

edto

ol

that

reli

eson

rule

-

bas

edal

gori

thm

s

der

ived

from

exper

tknow

ledge

of

pai

nsp

ecia

list

s

Use

ras

ked

ase

ries

of

ques

tions

to

refi

ne

the

dia

gnosi

s

and

det

erm

ine

appro

pri

ate

ther

apy

Inte

ract

ive

capab

ilit

y(e

.g.,

for

expla

nat

ions,

ther

apeu

tic

rati

onal

es,

ther

apy

guid

elin

es)

Work

ing

ver

sion

dev

eloped

:so

me

fiel

dte

stin

gco

nduct

ed

Com

pute

rpro

gra

m

PM

Aw

ritt

enin

Mic

roS

oft

Vis

ual

Bas

ic,

v.

5.0

,ru

n

asan

exper

t

appli

cati

on

in

Xper

tRule

Alg

ori

thm

sst

ore

din

Mic

roS

oft

Acc

ess

dat

abas

e

Mic

roS

oft

Hel

p

Uti

lity

use

dfo

r

expla

nat

ions

and

quer

ies

Pat

ient

dem

ogra

phic

s

Dia

gnosi

s

Pai

n

char

acte

rist

ics

Lab

ora

tory

test

s

and

imag

ing

studie

s

Curr

ent

med

icat

ions

Pri

or

ther

apie

s

Concu

rren

t

dis

ease

condit

ions

All

ergie

s

Psy

cholo

gic

al

stat

us

Apri

ori

tize

dli

stof

reco

mm

endat

ions:

(1)

med

ical

man

agem

ent

(phar

mac

olo

gic

and

nonphar

mac

olo

gic

al

man

agem

ent,

physi

cal,

psy

choso

cial

modal

itie

s);

(2)

invas

ive

pro

cedure

s;

(3)

refe

rral

s

Pri

mar

yca

re

pro

vid

ers.

This

soft

war

ew

as

only

test

ed

qual

itat

ivel

yin

one

study.

No

furt

her

test

ing

has

bee

npubli

shed

Dec

isio

nS

upport

Soft

war

e(D

SS

)

[38

]

To

det

erm

ine

whet

her

the

use

of

soft

war

eas

a

dec

isio

nsu

pport

syst

emca

nhel

p

wit

hev

aluat

ion

and

contr

ol

of

physi

cal

job

stre

sses

and

Com

pute

r-bas

edto

ol

consi

stin

gof

dec

isio

nsu

pport

soft

war

eis

a

spre

adsh

eet-

bas

ed

dat

abas

epro

gra

m

wri

tten

in

Mic

roso

ftE

xce

l.It

has

agra

phic

al

Tes

ting

usa

bil

ity

and

effe

ctiv

enes

s

topre

ven

tw

ork

erin

juri

es

No

furt

her

test

ing

The

dat

abas

ese

ems

tobe

use

ful

to

faci

lita

teth

equal

ity

of

job

eval

uat

ion.

This

impro

vem

ent

in

qual

ity

can

lead

tobet

ter

inte

rven

tion

and

contr

ol

of

MS

K

pro

ble

ms

[38

]

Pen

tium

-bas

edP

Cs

Idea

lly

a

port

able

com

pute

r

Win

dow

s95

Exce

lP

rogra

m

Vis

ual

inte

rfac

e

Upper

extr

emit

y

exposu

re

rati

ngs

(eval

uat

edby

the

rese

arch

team

)fo

r

repet

itio

n,

post

ure

,

Info

rmat

ion

from

dat

abas

ew

asuse

dto

mak

e

reco

mm

endat

ions

for

inju

rypre

ven

tion

and

man

agem

ent

stra

tegie

sby

the

ergonom

ists

Erg

onom

ists

This

soft

war

ew

as

only

test

ed

qual

itat

ivel

yin

one

study.

No

furt

her

test

ing

has

bee

npubli

shed

[38

]

J Occup Rehabil

123

Author's personal copy

Page 12

Table

2co

nti

nu

ed

Nam

eof

CD

SS

Purp

ose

Des

crip

tion

Sta

ge

of

Dev

elopm

ent

Har

dw

are

and

Soft

war

e

Dat

aIn

put

Req

uir

emen

ts

Outp

ut(

s)T

arget

Rec

ipie

nt

of

Outp

ut

Lim

itat

ions

pre

ven

tre

-inju

ry

of

work

ers

who

hav

e

exper

ience

dor

are

conce

rned

about

work

-

rela

ted

musc

ulo

skel

etal

dis

ord

ers

The

ergonom

ists

use

dth

e

dat

abas

eas

a

dec

isio

nsu

pport

tool

inth

e

contr

ol

of

work

-

rela

ted

MS

K

dis

ord

ers

(WM

SD

s)

use

rin

terf

ace

(GU

I)in

the

Win

dow

sTM

envir

onm

ent,

and

conta

ins

vid

eo

clip

sof

repre

senta

tive

cycl

esof

the

sele

cted

job

and

in

som

eca

ses,

mult

iple

vid

eos

show

ing

mult

iple

vie

ws

Itw

asdes

igned

spec

ifica

lly

for

the

site

,but

is

adap

table

tooth

er

man

ufa

cturi

ng

pla

nts

wit

h

rela

tivel

y

stab

lew

ork

pat

tern

s.T

he

soft

war

epro

gra

m

isa

dat

abas

eth

at

store

sdet

aile

djo

b

info

rmat

ion

such

asst

andar

diz

ed

work

dat

a,vid

eos,

and

upper

-

extr

emit

yphysi

cal

stre

ssra

tings

for

over

400

jobs

in

the

pla

nt.

Addit

ional

ly,

the

dat

abas

euse

rs

wer

eab

leto

reco

rd

com

men

tsab

out

the

jobs

and

rela

ted

contr

ol

issu

es

For

vid

eoim

port

,

mpg

imag

esar

e

nee

ded

conta

ctst

ress

,

and

forc

e

Sta

ndar

ddat

a:

work

elem

ents

and

tim

esfo

r

sele

cted

job,

obta

ined

from

the

com

pan

y

stan

dar

ddat

a

syst

em

-Tex

tbox

that

allo

ws

use

rsto

store

and

retr

ieve

com

men

ts

about

sele

cted

job

-Men

uto

sear

ch

for

ajo

bby

dep

artm

ent,

sect

ion,

line

posi

tion,

and

by

dat

e

Vid

eos

of

the

work

envir

onm

ent

Soft

Tis

sue

Conti

nuum

of

Car

eM

odel

[37

]

The

model

was

des

igned

asa

hig

h-l

evel

,

dec

isio

n-m

akin

g

tool

or

‘‘ro

adm

ap’’

to

pro

mote

a

consi

sten

t,

evid

ence

-bas

ed

appro

ach

to

The

model

wit

h

com

pute

r-bas

ed

tool

that

involv

es3

mai

nco

mponen

ts:

(1)

Sta

ged

appli

cati

on

of

rehab

ilit

atio

n

serv

ices

;(2

)C

ase

man

agem

ent

pro

toco

lsan

dca

se

pla

nnin

g

Apopula

tion-b

ased

,quas

i-

exper

imen

tal,

bef

ore

-and-a

fter

des

ign

wit

hco

ncu

rren

tco

ntr

ol

gro

ups

was

use

dto

eval

uat

eth

e

model

’sim

pac

tan

def

fect

iven

ess

Com

pute

r-bas

ed

pro

mpts

wer

e

giv

ento

work

ers’

com

pen

sati

on

case

man

ager

svia

a

cust

om

-buil

t

pro

gra

m

Dat

aon

type

of

inju

ryan

d

tim

esi

nce

inju

ryis

use

d

from

wit

hin

the

work

ers’

com

pen

sati

on

adm

inis

trat

ive

dat

abas

eto

gen

erat

e

Bas

edon

type

of

inju

ry

and

tim

eof

reco

ver

y,

clai

man

tsar

ere

ferr

ed

todif

fere

nt

asse

ssm

ent

and

trea

tmen

tpro

gra

ms

Work

ers’

com

pen

sati

on

case

man

ager

s

Furt

her

val

idat

ion

of

this

model

is

reco

mm

ended

thro

ugh

the

imple

men

tati

on

of

exper

imen

tal

des

ign

such

as

RC

T

J Occup Rehabil

123

Author's personal copy

Page 13

Table

2co

nti

nu

ed

Nam

eof

CD

SS

Purp

ose

Des

crip

tion

Sta

ge

of

Dev

elopm

ent

Har

dw

are

and

Soft

war

e

Dat

aIn

put

Req

uir

emen

ts

Outp

ut(

s)T

arget

Rec

ipie

nt

of

Outp

ut

Lim

itat

ions

man

age

soft

tiss

ue

inju

ries

chec

kpoin

ts;

and

(3)

Contr

acte

d

serv

ices

wit

h

pro

vid

ers

pro

mpts

for

case

man

ager

s

Work

Ass

essm

ent

Tri

age

Tool

(WA

TT

)[3

2]

The

clas

sifi

cati

on

algori

thm

and

acco

mpan

yin

g

com

pute

r-bas

ed

CD

Sto

ol

hel

p

cate

gori

ze

inju

red

work

ers

tow

ard

opti

mal

rehab

ilit

atio

n

inte

rven

tions

bas

edon

uniq

ue

work

er

char

acte

rist

ics

Com

pute

r-bas

edto

ol

com

pri

sed

of

18

var

iable

sre

late

d

to:

inju

rydura

tion,

occ

upat

ion,

job

atta

chm

ent

and

work

ing

stat

us

at

tim

eof

RT

W

asse

ssm

ent,

avai

labil

ity

of

modifi

edw

ork

,

Nat

ional

Occ

upat

ional

Cla

ssifi

cati

on

Code,

ICD

9dia

gnost

ic

gro

up,

cale

ndar

day

sin

jury

to

asse

ssm

ent,

the

‘Occ

upat

ion’

item

from

the

PD

I

Pai

nV

AS

out

of

10,

and

9it

ems

from

the

SF

36

(ite

ms

2,

4,

5,

7,

12,

14,

18,

21,

25)

The

algori

thm

use

dby

the

WA

TT

was

dev

eloped

usi

ng

mac

hin

e

lear

nin

gte

chniq

ues

and

dem

onst

rate

dhig

hac

cura

cyfo

r

corr

ect

clas

sifi

cati

ons

duri

ng

inte

rnal

val

idat

ion

[32

,41

]

Concu

rren

tval

idit

yof

WA

TT

wit

hcl

inic

ian’s

reco

mm

endat

ions

was

test

ed.

Per

cent

agre

emen

t

bet

wee

ncl

inic

ian

and

WA

TT

reco

mm

endat

ions

was

low

to

moder

ate.

The

WA

TT

did

not

impro

ve

upon

clin

icia

n

reco

mm

endat

ions,

but

was

more

likel

yto

reco

mm

end

evid

ence

-

bas

edin

terv

enti

ons

[42

]

HT

ML

-bas

ed

com

pute

rpro

gra

m

that

can

run

on

any

com

pute

rsy

stem

wit

hac

cess

toth

e

Inte

rnet

Dat

aen

tere

d

into

WA

TT

involv

es18

item

sre

late

d

toin

jury

dura

tion,

occ

upat

ion,

job

atta

chm

ent

and

work

ing

stat

us

atti

me

of

RT

W

asse

ssm

ent,

avai

labil

ity

of

modifi

ed

work

,N

atio

nal

Occ

upat

ional

Cla

ssifi

cati

on

Code,

ICD

9

dia

gnost

ic

gro

up,

cale

ndar

day

s

inju

ryto

asse

ssm

ent,

the

‘Occ

upat

ion’

item

from

the

PD

I,P

ain

VA

Sout

of

10,

and9

item

s

from

the

SF

36

(ite

ms

2,

4,

5,

7,

12,

14,

18,

21,

25)

The

rehab

ilit

atio

n

opti

ons

avai

lable

to

clin

icia

ns

wer

e:

physi

cal

ther

apy,

inte

rdis

cipli

nar

y

funct

ional

rest

ora

tion,

work

pla

ce-b

ased

rehab

ilit

atio

n,

‘hybri

d’

funct

ional

rest

ora

tion/w

ork

pla

ce-

bas

edre

hab

ilit

atio

n;

com

ple

x

inte

rdis

cipli

nar

ybio

-

psy

choso

cial

rehab

ilit

atio

nan

dno

furt

her

rehab

ilit

atio

n

Pri

mar

yca

re

pro

vid

ers

and

case

man

ager

s

This

tool

isat

the

earl

yst

ages

of

val

idat

ion.

Fin

din

gs

do

not

pro

vid

eev

iden

ce

of

concu

rren

t

val

idit

yof

the

WA

TT

agai

nst

clin

icia

n

reco

mm

endat

ions.

WA

TT

appea

red

more

likel

yth

an

clin

icia

ns

to

reco

mm

end

trea

tmen

ts

support

edby

curr

ent

evid

ence

such

asw

ork

pla

ce-

bas

ed

inte

rven

tions.

Furt

her

val

idat

ion

isnee

ded

J Occup Rehabil

123

Author's personal copy

Page 14

Table

3S

um

mar

yta

ble

of

ori

gin

alst

ud

ies

eval

uat

ing

com

pu

ter-

bas

edto

ols

or

qu

esti

on

nai

res

for

sele

ctin

gin

terv

enti

on

sfo

rp

atie

nts

wit

hm

usc

ulo

skel

etal

dis

ord

ers

Au

tho

rs

(ID

)

Yea

rS

tud

yd

esig

nP

op

ula

tio

nB

od

y

par

t

Co

nte

xt

To

ol

men

tio

ned

Pro

per

ties

test

edM

eth

od

sO

utc

om

eR

esu

lts

Hil

let

al.

[34]

2011

RC

T851

adult

sag

edC

18

yea

rs

wit

hlo

wbac

kpai

nw

ith

or

wit

hout

radic

ulo

pat

hy

Low

Bac

kT

engen

eral

pra

ctic

e

clin

ics

in

Engla

nd

Ques

tionnai

re:

Kee

leS

Tar

T

Bac

k

Scr

eenin

g

Tool

that

stra

tifi

es

pat

ients

into

low

,m

ediu

m

or

hig

hri

sk,

requir

ing

dif

fere

nt

inte

rven

tions

Val

idit

yof

a

stra

tifi

ed/c

lass

ifica

tion

appro

ach

topri

mar

y

care

Sen

siti

vit

y/s

pec

ifici

tyfo

r

iden

tify

ing

trea

tmen

ts

Eli

gib

lepat

ients

wer

era

ndom

ly

assi

gned

toin

terv

enti

on

(use

of

SB

ST

toin

form

man

agem

ent)

or

contr

ol

gro

up

(usu

alca

re).

Dis

abil

ity,

cost

and

qual

ity

of

life

wer

eev

aluat

ed

Res

ult

sin

dic

ate

a

clas

sifi

cati

on

appro

ach

usi

ng

the

tool

signifi

cantl

y

impro

ves

pat

ient

outc

om

esan

dis

asso

ciat

edw

ith

subst

anti

al

econom

icben

efits

Posi

tive

Hil

let

al.

[33]

2010

Met

hodolo

gic

al

study

12

conse

cuti

vel

y

consu

ltin

gpat

ients

wit

h

pri

mar

yca

rebac

kpai

n

Low

Bac

k8

Gen

eral

Pra

ctic

esin

the

Unit

ed

Kin

gdom

Ques

tionnai

re:

Kee

leS

Tar

T

Bac

k

Scr

eenin

g

Tool

that

stra

tifi

es

pat

ients

into

low

,m

ediu

m

or

hig

hri

sk,

requir

ing

dif

fere

nt

inte

rven

tions

Agre

emen

tbet

wee

n

clin

icia

ns

and

ST

arT

Bac

kto

ol

12

pat

ients

under

wen

ta

vid

eo-

reco

rded

clin

ical

asse

ssm

ent.

The

SB

ST

was

com

ple

ted

on

the

sam

eday

.C

linic

alex

per

ts

revie

wed

the

vid

eos

and

cate

gori

zed

subje

cts

tolo

w,

med

ium

or

hig

h-r

isk

Cli

nic

ians

mak

e

inco

nsi

sten

tri

sk

esti

mat

ions

for

pri

mar

yca

re

pat

ients

wit

hbac

k

pai

nw

hen

usi

ng

intu

itio

nal

one,

wit

hli

ttle

agre

emen

tw

ith

the

ST

arT

Bac

kto

ol

Uncl

ear

Spek

leet

al.

[40]

2010

Clu

ster

RC

T741

com

pute

rw

ork

ers

from

7D

utc

h

org

anis

atio

ns

invar

ious

work

bra

nch

es(e

.g.,

hea

lth

care

,lo

cal

gover

nm

ent,

nat

ure

conse

rvat

ion,

engin

eeri

ng,

educa

tion

and

regula

tory

affa

irs)

,

loca

ted

thro

ughout

the

Net

her

lands

The

popula

tion

consi

sted

of

offi

cest

aff,

loca

l

gover

nm

ent

offi

cial

s,

engin

eers

,co

nsu

ltan

ts,

teac

her

s,hea

lth

care

per

sonnel

,nat

ure

conse

rvat

ion

pro

fess

ional

s,

rese

arch

ers

and

man

ager

s

Arm

,

should

er

and

nec

k

pai

n

Em

plo

yee

sof

a

larg

e

occ

upat

ional

hea

lth

serv

ice

inth

e

Net

her

lands

Ques

tionnai

re:

RS

I

Quic

kS

can

inte

rven

tion

pro

gra

m

Eff

ecti

ven

ess

of

the

inte

rven

tion

pro

gra

m

for

reduci

ng

sym

pto

ms

and

sick

leav

e

The

par

tici

pan

tsw

ere

assi

gned

to

eith

eran

inte

rven

tion

or

usu

al

care

gro

up

by

mea

ns

of

clust

er

random

izat

ion.

At

bas

elin

ean

d

afte

r12

month

sof

foll

ow

-up,

par

tici

pan

tsco

mple

ted

the

RS

I

Quic

kS

can

ques

tionnai

reto

det

erm

ine

exposu

reto

the

risk

fact

ors

and

pre

val

ence

of

arm

,

should

eran

dnec

ksy

mpto

ms.

A

tail

or-

mad

ein

terv

enti

on

pro

gra

mw

aspro

pose

dto

par

tici

pan

tsw

ith

hig

h-r

isk

pro

file

sat

bas

elin

e.E

xam

ple

s

of

imple

men

ted

inte

rven

tions

are

anin

div

idual

work

stat

ion

chec

k,

avis

itto

the

occ

upat

ional

hea

lth

physi

cian

and

aned

uca

tion

pro

gra

mon

the

pre

ven

tion

of

arm

,sh

ould

er

and

nec

ksy

mpto

ms

Ther

ew

ere

no

signifi

cant

dif

fere

nce

sin

chan

ges

inth

e

pre

val

ence

of

arm

,

should

eran

dnec

k

sym

pto

ms

or

sick

leav

ebet

wee

nth

e

inte

rven

tion

and

usu

alca

regro

up

Neg

ativ

e

J Occup Rehabil

123

Author's personal copy

Page 15

Table

3co

nti

nu

ed

Auth

ors

(ID

)Y

ear

Stu

dy

des

ign

Popula

tion

Body

par

tC

onte

xt

Tool

men

tioned

Pro

per

ties

test

edM

ethods

Outc

om

eR

esult

s

Spek

leet

al.

[52]

2010

Eco

nom

ic

eval

uat

ion

alongsi

de

a

clust

erR

CT

638

com

pute

ruse

rsw

ith

and

wit

hout

should

er,

arm

and

nec

ksy

mpto

ms

Arm

,

should

er

and

nec

k

Work

ers

from

seven

Dutc

h

com

pan

ies

Ques

tionnai

re:

RS

I

Quic

kS

can

inte

rven

tion

pro

gra

m

Cost

–ben

efit

of

the

RS

I

Quic

kS

can

pro

gra

m

Work

ers

wer

era

ndom

ized

to

eith

erth

ein

terv

enti

on

or

usu

al

care

gro

up.

The

inte

rven

tion

consi

sted

of

ata

ilor-

mad

e

pro

gra

mbas

edon

the

RS

I-

Quic

kS

can

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m.

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alca

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gro

up

did

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ive

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ora

te

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e.T

he

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tici

pan

ts

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ple

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ques

tionnai

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elin

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d12-m

onth

foll

ow

-

up.

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ecti

ven

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and

cost

wer

e

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par

ed

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RS

IQ

uic

kS

can

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rven

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gra

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ve

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cost

-

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ctiv

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ever

,w

ith

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all

inves

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e

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gra

min

crea

sed

the

num

ber

of

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ers

who

rece

ived

info

rmat

ion

on

hea

lthy

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pute

r

use

and

impro

ved

thei

rw

ork

post

ure

and

movem

ent

Neg

ativ

e

Shaw

etal

.

[36]

2013

Cohort

study

496

work

ers

wit

hac

ute

(few

erth

an14

day

s)

work

-rel

ated

low

bac

k

pai

n

Low

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kA

pri

vat

e

net

work

of

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upat

ional

hea

lth

clin

ics

inth

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SA

wit

hei

ght

par

tici

pat

ing

clin

ics

loca

ted

invar

ious

stat

es

Ques

tionnai

re:

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Pai

n

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over

y

Inven

tory

of

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rns

and

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tati

ons

(PR

ICE

)

mea

sure

.

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igned

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ients

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hin

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ks

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isode

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n

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ine

nee

ded

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t

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endin

gon

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dis

abil

ity

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ted

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n

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iefs

,

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onal

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tres

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work

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ce

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rns

Sen

siti

vit

yan

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s

conduct

edto

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num

ber

of

item

s

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em

ainta

inin

g

scal

ere

liab

ilit

y,

then

clas

sifi

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on

accu

racy

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test

edusi

ng

a

confi

rmat

ory

clust

er

anal

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s

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ients

wer

ere

cruit

edfr

om

the

conse

cuti

ve

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load

of

pat

ients

report

ing

low

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k

pai

n,

and

volu

nte

erpat

ients

com

ple

ted

abri

efdem

ogra

phic

ques

tionnai

rean

da

10-p

age

psy

choso

cial

test

bat

tery

.

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tici

pan

tsw

ere

then

foll

ow

ed-u

pat

3-m

onth

sto

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erm

ine

pai

n,

funct

ion,

and

work

stat

us

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reduce

dP

RIC

E

mea

sure

isa

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tem

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g

mea

sure

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can

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dto

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tify

earl

yin

terv

enti

on

nee

ds

of

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ing

adult

sw

ith

low

bac

kpai

n

Uncl

ear

Not

test

ing

effe

ctiv

enes

s,

only

dev

elopm

ent

J Occup Rehabil

123

Author's personal copy

Page 16

Table

3co

nti

nu

ed

Auth

ors

(ID

)Y

ear

Stu

dy

des

ign

Popula

tion

Body

par

tC

onte

xt

Tool

men

tioned

Pro

per

ties

test

edM

ethods

Outc

om

eR

esult

s

Ara

ven

a-

Pae

z[3

9]

2014

Ret

rosp

ecti

ve

cohort

study

2046

work

ers

com

pen

sati

on

clai

man

ts

wit

hbac

kdis

ord

ers

Low

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kR

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ilit

atio

n

faci

liti

esin

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erta

,

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ada

wit

h

contr

acts

to

trea

tw

ork

ers’

com

pen

sati

on

clai

man

ts

Ques

tionnai

re:

OM

PQ

.

Scr

eenin

g

tool

aim

edat

iden

tify

ing

hig

h-r

isk

pat

ients

wit

h

MS

Kpai

nin

nee

dof

earl

y

inte

rven

tion

Tes

ted

level

of

agre

emen

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wee

n

clin

icia

n

reco

mm

endat

ions

and

OM

PQ

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gori

es.

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oex

amin

ed

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her

am

atch

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wee

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MP

Q

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gori

esan

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gra

ms

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e

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ith

bet

ter

RT

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om

es

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ondar

yan

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ol.

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ined

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her

am

atch

bet

wee

nO

MP

Qca

tegori

es,

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icia

nre

com

men

dat

ions

and

actu

alre

hab

pro

gra

m

under

taken

was

rela

ted

toa

bet

ter

retu

rnto

work

outc

om

e

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OM

PQ

had

lim

ited

agre

emen

t

wit

hcl

inic

ian

reco

mm

endat

ions

sugges

ting

oth

er

mea

sure

sor

fact

ors

are

consi

der

edw

hen

mak

ing

trea

tmen

t

reco

mm

endat

ions.

Fin

ally

,

conco

rdan

ceof

OM

PQ

cate

gori

zati

on

and

actu

al

rehab

ilit

atio

n

under

taken

did

not

appea

rto

favora

bly

impac

t

outc

om

es

Neg

ativ

e

Knab

etal

.

[35]

2001

Quas

i-

exper

imen

tal

study

100

pat

ients

wit

hch

ronic

pai

nre

ferr

edfo

r

trea

tmen

tat

ach

ronic

pai

ncl

inic

All

VA

San

Die

go

Hea

lthca

re

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emP

ain

Cli

nic

inth

e

Unit

edS

tate

s

Com

pute

rize

d:

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n

man

agem

ent

advis

or

(PM

A)

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idit

yan

d

acce

pta

bil

ity

of

reco

mm

endat

ions

mad

ebas

edon

a

com

pute

rize

dto

ol

Apai

nsp

ecia

list

use

da

dec

isio

n

support

syst

emto

det

erm

ine

appro

pri

ate

pai

nth

erap

yan

d

sent

lett

ers

toth

ere

ferr

ing

physi

cian

soutl

inin

gth

ese

reco

mm

endat

ions.

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arat

ely,

five

boar

d-c

erti

fied

PC

Ps

use

da

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DS

syst

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‘‘tr

eat’

’th

e50

case

s.P

atie

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wer

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llow

ed

up

1-y

ear

late

r

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use

of

a

Com

pute

r-B

ased

Dec

isio

n-S

upport

syst

emm

ay

impro

ve

the

abil

ity

of

pri

mar

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re

physi

cian

sto

man

age

chro

nic

pai

nan

dm

ay

faci

lita

tesc

reen

ing

of

consu

lts

to

opti

miz

esp

ecia

list

uti

liza

tion

Posi

tive

Wom

ack

and

Arm

stro

ng

[38]

2005

Quas

i-

exper

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tal

study

Work

ers

inan

auto

mobil

e

asse

mbly

pla

nt

conduct

ing

over

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jobs

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emit

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site

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mil

lion

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ot

faci

lity

.T

her

e

wer

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on-

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Com

pute

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n

support

syst

em(D

SS

)

for

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ists

bet

ter

mat

ch

work

ers

wit

h

the

work

envir

onm

ent

Uti

lity

of

the

tool

over

a

20-m

onth

per

iod

Eval

uat

ion

of

qual

itat

ive

com

men

tsre

gar

din

guti

lity

of

the

tool

asw

ell

as1-o

n-1

sem

i-

stru

cture

din

terv

iew

sw

ith

use

rs

Of

197

com

men

ts

ente

red

by

use

rs,

25

%per

tain

edto

pri

mar

y

pre

ven

tion,

75

%

per

tain

edto

seco

ndar

y

pre

ven

tion,

and

94

com

men

ts

(47.7

%)

des

crib

ed

ergonom

ic

inte

rven

tions.

Use

of

the

soft

war

e

tool

impro

ved

the

qual

ity

and

effi

cien

cyof

the

ergonom

icjo

b

anal

ysi

spro

cess

Posi

tive

J Occup Rehabil

123

Author's personal copy

Page 17

Table

3co

nti

nu

ed

Auth

ors

(ID

)Y

ear

Stu

dy

des

ign

Popula

tion

Body

par

tC

onte

xt

Tool

men

tioned

Pro

per

ties

test

edM

ethods

Outc

om

eR

esult

s

Ste

phen

san

d

Gro

ss[3

7]

2007

Quas

i-

exper

imen

tal

study

171,7

36

work

ers’

com

pen

sati

on

clai

man

ts

wit

han

yty

pe

of

MS

K

inju

ryag

ed18–65

yea

rs

All

Reh

abil

itat

ion

faci

liti

esin

Alb

erta

,

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ada

wit

h

contr

acts

to

trea

tw

ork

ers’

com

pen

sati

on

clai

man

ts

Soft

Tis

sue

Inju

ry

Conti

nuum

of

Car

eM

odel

wit

h

com

pute

rize

d

pro

mpts

for

case

man

ager

s

Eff

ecti

ven

ess

of

the

tool

com

par

edto

usu

alca

re

Apopula

tion-b

ased

,quas

i-

exper

imen

tal,

bef

ore

-and-a

fter

des

ign

wit

hco

ncu

rren

tco

ntr

ol

gro

ups

was

use

dto

eval

uat

eth

e

model

’sim

pac

t.D

ata

wer

e

extr

acte

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om

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mai

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-

Alb

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adm

inis

trat

ive

dat

abas

e

from

2yea

rsbef

ore

model

imple

men

tati

on

to5

yea

rsaf

ter

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men

tati

on

of

a

soft

tiss

ue

inju

ry

conti

nuum

of

care

involv

ing

stag

ed

appli

cati

on

of

var

ious

types

of

rehab

ilit

atio

n

serv

ices

appea

rsto

hav

ere

sult

edin

more

rapid

and

sust

ained

reco

ver

y

Posi

tive

Gro

sset

al.

[32]

2013

Cohort

study

8611

inju

red

Can

adia

n

work

ers’

com

pen

sati

on

clai

man

tsw

ith

any

type

of

MS

Kin

jury

bet

wee

n

18

and

65

yea

rsold

All

Reh

abil

itat

ion

faci

liti

esin

Alb

erta

,

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ada

wit

h

contr

acts

to

trea

tw

ork

ers’

com

pen

sati

on

clai

man

ts

Com

pute

rize

d:

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Ass

essm

ent

Tri

age

Tool

Cla

ssifi

cati

on

accu

racy

of

the

tool

Dat

aw

ere

extr

acte

dfr

om

a

work

ers’

com

pen

sati

on

dat

abas

ean

dm

achin

e-le

arnin

g

tech

niq

ues

wer

euse

dto

gen

erat

ean

dte

sta

tool

AC

DS

tool

was

dev

eloped

for

sele

ctin

g

rehab

ilit

atio

n

inte

rven

tions

for

inju

red

work

ers.

Pre

lim

inar

y

val

idat

ion

was

also

conduct

ed

Not

test

ing

effe

ctiv

enes

s,

only

tool

dev

elopm

ent

Zhan

get

al.

[41]

2013

Met

hodolo

gic

al

study

(rule

-

bas

ed

clas

sifi

ers)

8611

inju

red

Can

adia

n

work

ers’

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pen

sati

on

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man

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ith

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type

of

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jury

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rsold

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esin

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erta

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contr

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to

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pen

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on

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man

ts

Com

pute

rize

d:

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Ass

essm

ent

Tri

age

Tool

Acc

ura

cyof

var

ious

rule

-

bas

edcl

assi

fier

s

Dat

aw

ere

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acte

dfr

om

a

work

ers’

com

pen

sati

on

dat

abas

ean

dvar

ious

mac

hin

e-

lear

nin

gte

chniq

ues

and

rule

-

bas

edcl

assi

fier

sw

ere

test

ed

This

pap

erpre

sents

a

des

crip

tion

of

the

algori

thm

dev

elopm

ent

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aco

mpute

r

scie

nce

/mac

hin

e

lear

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g

per

spec

tive

Not

test

ing

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ctiv

enes

s,

only

tool

dev

elopm

ent

Qin

etal

.

[42]

2015

Cro

ssse

ctio

nal

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inju

red

Can

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n

work

ers’

com

pen

sati

on

clai

man

tsw

ith

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type

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MS

Kin

jury

bet

wee

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18

and

65

yea

rsold

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ers’

com

pen

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on

rehab

ilit

atio

n

faci

lity

in

Alb

erta

,

Can

ada

Com

pute

rize

d:

Work

Ass

essm

ent

Tri

age

Tool

(WA

TT

).

Des

igned

to

cate

gori

ze

inju

red

work

ers

to

var

ious

pro

gra

ms

incl

udin

g

funct

ional

rest

ora

tion,

work

pla

ce-

bas

ed

inte

rven

tion,

or

chro

nic

pai

npro

gra

ms

Concu

rren

tval

idit

yof

the

tool’

s

reco

mm

endat

ions

Lev

elof

agre

emen

tw

as

exam

ined

bet

wee

nth

eW

AT

T

and

clin

ical

reco

mm

endat

ions

by

ther

apis

tspar

tici

pat

ing

ina

clin

ical

tria

l

Per

cent

agre

emen

t

bet

wee

ncl

inic

ian

and

WA

TT

reco

mm

endat

ions

was

low

to

moder

ate.

The

WA

TT

did

not

impro

ve

upon

clin

icia

n

reco

mm

endat

ions

Uncl

ear

J Occup Rehabil

123

Author's personal copy

Page 18

challenging. Most of the algorithms or decision models

were developed to determine possible treatment paths.

Nevertheless, most testing of these algorithms/decision

models was preliminary or exploratory (e.g., small sample

size, secondary analyses of previous collected data, lack of

replication or validation samples, use of research designs

that are prone to bias including case series, cross sectional

or cohort studies rather than randomized controlled trials).

Nine of these algorithms [54, 58, 62–67, 76] seemed to lead

to positive results when deciding on intervention strategies.

Nevertheless, one study [56] found that the use of the

algorithm would not result in better outcomes for patients

with low back pain. Four studies [55, 57, 59, 61] only

looked at the development of an algorithm/model without

associated testing of it.

Clinical Prediction Rules/Classification Systems

The remaining 79 articles [76–154] looked at 21 unique

clinical prediction rules or classification systems. Four

articles described the clinical prediction rules in general.

Most of these studies targeted rules for identifying

responders to interventions for low back pain (8 rules)

followed by neck pain (6 rules), patellofemoral pain (3

rules), lateral epicondylagia (2 rules), ankle sprain (1 rule)

and thoracolumbar injury (1 rule). For details on the clin-

ical prediction rules and classification systems found in this

scoping review, see Table 6. The rules were developed to

determine response to specific treatments that included

spinal manipulation, stabilization exercises, McKenzie

approach, mechanical traction, Pilates-based exercise, foot

orthoses, patellar taping, or general classification models.

From the rules looking at back pain (8 rules in total

involving 47 articles [77–121, 150, 152]), three rules (rules

for manipulation and stabilization exercise, and the treat-

ment-based classification system) have been the most

commonly studied. Confirmatory evaluation of these rules

has shown mixed or unsuccessful results. The remaining 5

rules (rules for the McKenzie approach, mechanical trac-

tion, Pilates, and the CBI Health classification system)

have been developed empirically or theoretically but no

confirmatory testing has been conducted. Thus, it is

unknown if the results from these studies would provide

clarification regarding management of patients with back

pain.

Six rules discussed in 18 articles targeted neck pain

[122–139]. From these rules, only one (treatment-based

classification system) showed positive results when tested

in case series, pilot and cohort studies. However, this rule

has not been tested in a randomized controlled trial. The

remaining 5 rules for neck pain were either unsuccessful

(rule for thoracic manipulation) or had no confirmatory

testing evidence. From the rules developed for patellofe-

moral pain, 2 rules discussed in 5 articles [140–143, 146]

(1 rule for patellar taping and 1 for foot orthoses) were not

tested further and 1 rule for lumbopelvic manipulation

obtained unsuccessful results when tested in a separate

sample. The remaining rules developed for lateral epi-

condylalgia (2 rules in 2 articles [147, 149]), ankle sprain

(1 rule in 1 article [148]) and thoracolumbar injury (1 rule

in 2 articles [144, 145]) did not have additional testing. Of

note, there were 3 interventions where two separate rules

were generated for the same condition (traction for low

back pain, manipulation for neck pain, and foot orthoses

Table 4 Summary of the quality of measurement properties of the computer-based tools or questionnaires located

Tool Internal

consistency

Face

validity

Content

validity

Criterion

validity*

Construct

validity

Reproducibility

(agreement/reliability)

StarT Back ? ? ? ?* ? ?

RSI Quick Scan ? ? ? – ? ?

PRICE ? ? ? – ? –

PMA – ? ? ? ? –

DSS – ? ? – – –

Soft Tissue Model – ? ? – ? –

WATT – ? ? ? ? –

? Quality of measurements properties were based on guidelines established by Terwee et al. [31]

(?) Criterion accomplished

(-) Criterion not accomplished

* Comparison was performed with reference standards

J Occup Rehabil

123

Author's personal copy

Page 19

Table

5S

um

mar

yta

ble

of

ori

gin

alst

ud

ies

des

crib

ing

or

eval

uat

ing

alg

ori

thm

so

rd

ecis

ion

-mo

del

s(t

heo

reti

cal

or

emp

iric

al)

for

sele

ctin

gin

terv

enti

on

sfo

rp

atie

nts

wit

hm

usc

ulo

skel

etal

dis

ord

ers

Au

tho

rs

(ID

)

Yea

rS

tud

yd

esig

nB

od

y

par

t

Alg

ori

thm

/mo

del

men

tio

ned

Po

pu

lati

on

Met

ho

ds

Ou

tco

me/

con

clu

sio

nR

esu

lts

Hu

rdet

al.

[63]

20

08

Co

ho

rtst

ud

yK

nee

Alg

ori

thm

for

man

agin

g

subac

ute

ante

rior

ligam

ent

(AC

L)

inju

ries

was

crea

ted

usi

ng

clin

ical

info

rmat

ion

on

:

con

com

itan

tin

jury

,

un

reso

lved

imp

airm

ents

,an

d

resu

lts

of

asc

reen

ing

exam

inat

ion

345

hig

hly

acti

ve

adult

s(2

16

men

,1

29

wo

men

)w

ith

subac

ute

ante

rior

cruci

ate

lig

amen

tin

jury

aged

18–65

yea

rspre

senti

ng

toan

ort

ho

ped

icsu

rgeo

n

Pro

spec

tiv

efo

llo

w-u

pst

ud

y.

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ien

tsp

rese

nti

ng

wit

hin

7m

on

ths

of

thei

rin

jury

wer

e

trea

ted

usi

ng

adec

isio

n-

mak

ing

alg

ori

thm

.A

lgori

thm

was

use

das

crit

eria

tog

uid

e

man

agem

ent

and

clas

sify

ind

ivid

ual

sas

‘no

nco

per

s’

(po

or

po

ten

tial

)o

rp

ote

nti

al

‘co

per

s’(g

oo

dp

ote

nti

al)

for

no

n-o

per

ativ

eca

re.

Pat

ien

ts

wer

efo

llo

wed

up

for

the

du

rati

on

of

care

(up

to1

0P

T

sess

ion

so

ver

5w

eek

s)

19

9su

bje

cts

clas

sifi

edas

‘no

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per

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d1

46

as

po

ten

tial

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per

s’.

63

of

88

po

ten

tial

‘co

per

s’

succ

essf

ull

yre

turn

edto

pre

-

inju

ryac

tiv

itie

sw

ith

ou

t

surg

ery

,w

ith

25

of

thes

en

ot

un

der

go

ing

AC

L

reco

nst

ruct

ion

atfo

llo

w-u

p.

Th

eal

go

rith

msh

ould

be

con

sid

ered

asan

alte

rnat

ive

tom

anag

emen

tb

ased

on

ante

rio

rk

nee

lax

ity

,ag

e,an

d

pre

inju

ryac

tivit

yle

vel

s

Po

siti

ve

Ko

dam

a

etal

.[6

6]

20

13

Rev

iew

and

retr

osp

ecti

ve

stud

y

Wri

stS

cori

ng

syst

emfo

rse

lect

ing

trea

tmen

tfo

rd

ista

lra

diu

s

frac

ture

s.In

clu

des

av

arie

ty

of

clin

ical

fact

ors

rela

ted

to

the

frac

ture

,as

wel

las

do

min

ant

han

d,

hig

h

occ

upat

ional

or

recr

eati

onal

acti

vit

y,

age,

and

sup

ple

men

tal

fact

ors

(Tab

le2

inp

aper

)

16

4p

atie

nts

wit

hd

ista

lra

diu

s

frac

ture

wh

ow

ere

50

yea

rs

or

old

erp

rese

nti

ng

toa

surg

eon.

Dev

elopm

ent

of

the

dec

isio

n-

mak

ing

gu

ide

was

des

crib

ed,

and

then

are

trosp

ecti

ve

study

was

use

dto

eval

uat

eth

e

gu

ide

inp

atie

nts

.C

om

par

iso

n

was

mad

eo

ncl

inic

al

ou

tco

mes

(DA

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qu

esti

on

nai

resc

ore

s)

bet

wee

np

atie

nts

wh

ere

reco

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ide

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efo

llo

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t

foll

ow

ed

16

4p

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wer

ed

ivid

edin

to

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rou

ps

usi

ng

the

too

l:

con

serv

ativ

eca

re,

rela

tiv

e

con

serv

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eca

re,

rela

tiv

e

surg

ical

care

,an

dsu

rgic

al

care

.C

lin

ical

ou

tco

mes

of

those

that

foll

ow

edth

e

reco

mm

endat

ion

wer

eb

ette

r

than

those

no

tfo

llo

win

gth

e

reco

mm

endat

ion

.T

he

pre

sen

t

sco

rin

gsy

stem

isan

easy

-to-

use

dec

isio

n-m

akin

gto

ol

for

cho

osi

ng

con

serv

ativ

eo

r

surg

ical

trea

tmen

tfo

rd

ista

l

radiu

sfr

actu

res

Po

siti

ve

Mu

rphy

etal

.[7

6]

20

07

Co

ho

rtst

ud

yL

ow bac

k

Th

eap

pro

ach

isb

ased

on

3

qu

esti

on

s:(1

)A

reth

e

sym

pto

ms

refl

ecti

ve

of

a

vis

cera

ld

iso

rder

or

ase

rio

us/

po

ten

tial

lyli

fe-t

hre

aten

ing

dis

ease

?(2

)F

rom

wh

ere

is

the

pat

ien

t’s

pai

nar

isin

g?

(3)

Wh

ath

asg

on

ew

ron

gw

ith

this

per

son

asa

wh

ole

that

wo

uld

cau

seth

ep

ain

exp

erie

nce

tod

evel

op

and

per

sist

?

26

4p

atie

nts

wit

hm

od

erat

eto

sev

ere

low

bac

kp

ain

ov

er

18

yea

rso

ldp

rese

nti

ng

toa

pri

vat

epra

ctic

ephysi

cal

ther

apy

clin

ic

Cro

ss-s

ecti

on

alfe

asib

ilit

y

stu

dy

.D

emo

gra

ph

ic,

dia

gn

ost

ican

db

asel

ine

ou

tco

me

mea

sure

dat

aw

ere

gat

her

edo

na

coh

ort

of

low

bac

kp

ain

pat

ien

tsex

amin

ed

by

on

eo

fth

ree

exam

iner

s

trai

ned

inth

eap

pli

cati

on

of

a

dia

gn

osi

s-b

ased

clin

ical

dec

isio

nru

leth

atg

uid

ed

sub

sequ

ent

trea

tmen

t

Th

eg

uid

eca

nb

eap

pli

edin

a

pri

vat

ep

ract

ice

sett

ing

Itap

pea

rsth

atp

atie

nts

wit

h

low

bac

kp

ain

can

be

dis

tin

gu

ish

edo

nth

eb

asis

of

this

app

roac

h,

and

trea

tmen

t

pla

ns

can

be

form

ula

ted

uti

lizi

ng

this

stra

teg

y

Dev

elop

men

t

arti

cle

J Occup Rehabil

123

Author's personal copy