Background: Minimal clinically important difference (MCID) scores for outcome measures are frequently used evidence-based guides to gage meaningful changes. There are numerous outcome instruments used for analyzing pain, disability, and dysfunction of the low back; perhaps the most common of these is the Oswestry disability index (ODI). A single agreed-upon MCID score for the ODI has yet to be established. What is also unknown is whether selected baseline variables will be universal predictors regardless of the MCID used for a particular outcome measure. Objective: To explore the relationship between predictive models and the MCID cutpoint on the ODI. Setting: Data were collected from 16 outpatient physical therapy clinics in 10 states. Design: Secondary database analysis using backward stepwise deletion logistic regression of data from a randomized controlled trial (RCT) to create prognostic clinical prediction rules (CPR). Participants and Interventions: One hundred and forty-nine patients with low back pain (LBP) were enrolled in the RCT. All were treated with manual therapy, with a majority also receiving spine-strengthening exercises. Results: The resultant predictive models were dependent upon the MCID used and baseline sample characteristics. All CPR were statistically significant (P , 0.01). All six MCID cutpoints used resulted in completely different significant predictor variables with no predictor significant across all models. Limitations: The primary limitations include sub-optimal sample size and study design. Conclusions: There is extreme variability among predictive models created using different MCIDs on the ODI within the same patient population. Our findings highlight the instability of predictive modeling, as these models are significantly affected by population baseline characteristics along with the MCID used. Clinicians must be aware of the fragility of CPR prior to applying each in clinical practice.

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Dichromatism in songbirds is often associated with polygyny and dimorphic parental investment, and is thought to arise via sexual selection. Northern cardinals (Cardinalis cardinalis) are not only dichromatic but also monogamous and biparental, suggesting that plumage coloration in this species may serve different functions than in more typical dichromatic species. In order to explore the role of sexual selection in the evolution of plumage coloration in cardinals, we used reflectance spectrophotometry to investigate whether two carotenoid‐based ornaments, the male’s red breast and the female’s underwing coverts, contain information that potential mates or competitors could use to assess condition. We found that whereas coloration was not related to body condition (measured as the residual body mass from a regression of body mass on wing chord), more saturated carotenoid coloration was associated with higher heterophil to lymphocyte ratios in males, and with higher white blood cell counts in females. Thus, in both sexes, carotenoid coloration was positively linked to immune measures normally associated with higher levels of stress and infection. These results do not indicate that carotenoid‐based coloration functions as a signal of low levels of stress or disease in this species. We propose instead that because plumage coloration may be related to competitiveness, the more saturated individuals increase their risk of injury, stress, and infection by engaging in more competitive behavior or by secreting more testosterone, or both. Our finding that carotenoid pigmentation is positively associated in males with the size of the cloacal protuberance, an androgen‐sensitive sex character, supports this hypothesis.

The survey identified varied understanding of CPGs when making decisions that were similar in recommendation to the CPGs. No single predictor for correct responses for LBP CPGs was found.

Background Recovery from low back pain (LBP) is multidimensional and requires the use of multiple-response (outcome) measures to fully reflect these many dimensions. Predictive prognostic variables that are present or stable in all or most predictive models that use different outcome measures could be considered “universal” prognostic variables. Objective The aim of this study was to explore the potential of universal prognostic variables in predictive models for 4 different outcome measures in patients with mechanical LBP. Design Predictive modeling was performed using data extracted from a randomized controlled trial. Four prognostic models were created using backward stepwise deletion logistic, Poisson, and linear regression. Methods Data were collected from 16 outpatient physical therapy facilities in 10 states. All 149 patients with LBP were treated with manual therapy and spine strengthening exercises until discharge. Four different measures of response were used: Oswestry Disability Index and Numeric Pain Rating Scale change scores, total visits, and report of rate of recovery. Results The set of statistically significant predictors was dependent on the definition of response. All regression models were significant. Within both forms of the 4 models, meeting the clinical prediction rule for manipulation at baseline was present in all 4 models, whereas no irritability at baseline and diagnosis of sprains and strains were present in 2 of 4 of the predictive models. Limitations The primary limitation is that this study evaluated only 4 of the multiple outcome measures that are pertinent for patients with LBP. Conclusions Meeting the clinical prediction rule was prognostic for all outcome measures and should be considered a universal prognostic predictor. Other predictive variables were dependent on the outcomes measure used in the predictive model.

BackgroundThe purpose of the study was to determine if clinician predicted prognosis is associated with patient outcomes.MethodsThe study was a secondary analysis of data that were collected in 8 physiotherapy outpatient clinics. Nine physiotherapists with post-graduate training in manual therapy (mean 20.3 years of experience) were asked at baseline to project the outcome of the patients evaluated. In total, 112 patients with low back (74 %) or neck (26 %) pain were treated pragmatically with interventions consisting of manual therapy, strengthening, and patient-specific education. Outcomes measures consisted of percent change in disability (Oswestry or Neck Disability Index), self-reported rate of recovery (0–100 %), and percent change in pain (numerical pain rating scale). Hierarchical logistic regression determined potential factors (clinician predicted prognosis score (1–10) at baseline, dichotomised as poor (1–6) and good (7–10); symptom duration categorised as acute, subacute or chronic; same previous injury (yes/no); baseline pain and disability scores; within-session improvement at initial visit (yes/no); and presence of ≥ one psychological factor) associated with meaningful changes in each of the three outcomes at discharge (disability and pain > 50 % improvement, rate of recovery ≥82.5 % improvement).ResultsClinician predicted prognosis (OR 4.15, 95%CI = 1.31, 13.19, p = 0.02) and duration of symptoms (OR subacute 0.24, 95%CI = 0.07, 0.89, p = 0.03; chronic 0.21, 95%CI = 0.05, 0.90, p = 0.04) were associated with rate of recovery, whereas only clinician predicted prognosis was associated with disability improvement (OR 4.28, 95 % CI 1.37, 13.37, p = 0.01). No variables were associated with pain improvement.ConclusionsClinician predicted prognosis is potentially valuable for patients, as a good predicted prognosis is associated with improvements in disability and rate of recovery.

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