Mastering Prognostic Tools: An Opportunity to Enhance Personalized Care and to Optimize Clinical Outcomes in Physical Therapy

Author:

Tousignant-Laflamme Yannick12,Houle Catherine12,Cook Chad345,Naye Florian12,LeBlanc Annie6,Décary Simon12

Affiliation:

1. School of Rehabilitation , Université de Sherbrooke, Sherbrooke, Quebec, Canada

2. Research Center of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS) , Sherbrooke, Quebec, Canada

3. Physical Therapy Division , Duke University, Durham, North Carolina, USA

4. Department of Population Health Sciences , Duke University, Durham, North Carolina, USA

5. Duke Clinical Research Institute , Duke University, Durham, North Carolina, USA

6. Department of Family Medicine and Emergency Medicine , Université Laval, Quebec, Quebec, Canada

Abstract

Abstract   In health care, clinical decision making is typically based on diagnostic findings. Rehabilitation clinicians commonly rely on pathoanatomical diagnoses to guide treatment and define prognosis. Targeting prognostic factors is a promising way for rehabilitation clinicians to enhance treatment decision-making processes, personalize rehabilitation approaches, and ultimately improve patient outcomes. This can be achieved by using prognostic tools that provide accurate estimates of the probability of future outcomes for a patient in clinical practice. Most literature reviews of prognostic tools in rehabilitation have focused on prescriptive clinical prediction rules. These studies highlight notable methodological issues and conclude that these tools are neither valid nor useful for clinical practice. This has raised the need to open the scope of research to understand what makes a quality prognostic tool that can be used in clinical practice. Methodological guidance in prognosis research has emerged in the last decade, encompassing exploratory studies on the development of prognosis and prognostic models. Methodological rigor is essential to develop prognostic tools, because only prognostic models developed and validated through a rigorous methodological process should guide clinical decision making. This Perspective argues that rehabilitation clinicians need to master the identification and use of prognostic tools to enhance their capacity to provide personalized rehabilitation. It is time for prognosis research to look for prognostic models that were developed and validated following a comprehensive process before being simplified into suitable tools for clinical practice. New models, or rigorous validation of current models, are needed. The approach discussed in this Perspective offers a promising way to overcome the limitations of most models and provide clinicians with quality tools for personalized rehabilitation approaches. Impact Prognostic research can be applied to clinical rehabilitation; this Perspective proposes solutions to develop high-quality prognostic models to optimize patient outcomes.

Funder

Ordre Professionnel de la Physiothérapie du Québec

Publisher

Oxford University Press (OUP)

Subject

Physical Therapy, Sports Therapy and Rehabilitation

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