Red flags presented in current low back pain guidelines: a review.

Verhagen, AP; Downie, A; Popal, N; Maher, C; Koes, BW

Red flags presented in current low back pain guidelines: a review.

Verhagen, AP Downie, A Popal, N Maher, C Koes, BW

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Publisher:: SPRINGER
Publication Type:: Journal Article
Citation:: Eur Spine J, 2016, 25, (9), pp. 2788-2802
Issue Date:: 2016-09

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Field	Value	Language
dc.contributor.author	Verhagen, AP
dc.contributor.author	Downie, A
dc.contributor.author	Popal, N
dc.contributor.author	Maher, C
dc.contributor.author	Koes, BW
dc.date.accessioned	2022-07-18T04:23:32Z
dc.date.available	2016-06-23
dc.date.available	2022-07-18T04:23:32Z
dc.date.issued	2016-09
dc.identifier.citation	Eur Spine J, 2016, 25, (9), pp. 2788-2802
dc.identifier.issn	0940-6719
dc.identifier.issn	1432-0932
dc.identifier.uri	http://hdl.handle.net/10453/158992
dc.description.abstract	OBJECTIVE: The purpose of this study was to identify and descriptively compare the red flags endorsed in guidelines for the detection of serious pathology in patients presenting with low back pain to primary care. METHOD: We searched databases, the World Wide Web and contacted experts aiming to find the multidisciplinary clinical guideline in low back pain in primary care, and selected the most recent one per country. We extracted data on the number and type of red flags for identifying patients with higher likelihood of serious pathology. Furthermore, we extracted data on whether or not accuracy data (sensitivity/specificity, predictive values, etc.) were presented to support the endorsement of specific red flags. RESULTS: We found 21 discrete guidelines all published between 2000 and 2015. One guideline could not be retrieved and after selecting one guideline per country we included 16 guidelines in our analysis from 15 different countries and one for Europe as a whole. All guidelines focused on the management of patients with low back pain in a primary care or multidisciplinary care setting. Five guidelines presented red flags in general, i.e., not related to any specific disease. Overall, we found 46 discrete red flags related to the four main categories of serious pathology: malignancy, fracture, cauda equina syndrome and infection. The majority of guidelines presented two red flags for fracture ('major or significant trauma' and 'use of steroids or immunosuppressors') and two for malignancy ('history of cancer' and 'unintentional weight loss'). Most often pain at night or at rest was also considered as a red flag for various underlying pathologies. Eight guidelines based their choice of red flags on consensus or previous guidelines; five did not provide any reference to support the choice of red flags, three guidelines presented a reference in general, and data on diagnostic accuracy was rarely provided. CONCLUSION: A wide variety of red flags was presented in guidelines for low back pain, with a lack of consensus between guidelines for which red flags to endorse. Evidence for the accuracy of recommended red flags was lacking.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	SPRINGER
dc.relation.ispartof	Eur Spine J
dc.relation.isbasedon	10.1007/s00586-016-4684-0
dc.rights	This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms to use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at https://link.springer.com/article/10.1007/s00586-016-4684-0
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	0903 Biomedical Engineering, 1103 Clinical Sciences
dc.subject.classification	Orthopedics
dc.subject.mesh	Aortic Aneurysm
dc.subject.mesh	Bone Diseases, Infectious
dc.subject.mesh	Humans
dc.subject.mesh	Low Back Pain
dc.subject.mesh	Practice Guidelines as Topic
dc.subject.mesh	Primary Health Care
dc.subject.mesh	Spinal Fractures
dc.subject.mesh	Spinal Neoplasms
dc.subject.mesh	Humans
dc.subject.mesh	Bone Diseases, Infectious
dc.subject.mesh	Spinal Neoplasms
dc.subject.mesh	Low Back Pain
dc.subject.mesh	Aortic Aneurysm
dc.subject.mesh	Spinal Fractures
dc.subject.mesh	Primary Health Care
dc.subject.mesh	Practice Guidelines as Topic
dc.title	Red flags presented in current low back pain guidelines: a review.
dc.type	Journal Article
utslib.citation.volume	25
utslib.location.activity	Germany
utslib.for	0903 Biomedical Engineering
utslib.for	1103 Clinical Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health/GSH.Physiotherapy
utslib.copyright.status	open_access	*
dc.date.updated	2022-07-18T04:23:30Z
pubs.issue	9
pubs.publication-status	Published
pubs.volume	25
utslib.citation.issue	9

Abstract:

OBJECTIVE: The purpose of this study was to identify and descriptively compare the red flags endorsed in guidelines for the detection of serious pathology in patients presenting with low back pain to primary care. METHOD: We searched databases, the World Wide Web and contacted experts aiming to find the multidisciplinary clinical guideline in low back pain in primary care, and selected the most recent one per country. We extracted data on the number and type of red flags for identifying patients with higher likelihood of serious pathology. Furthermore, we extracted data on whether or not accuracy data (sensitivity/specificity, predictive values, etc.) were presented to support the endorsement of specific red flags. RESULTS: We found 21 discrete guidelines all published between 2000 and 2015. One guideline could not be retrieved and after selecting one guideline per country we included 16 guidelines in our analysis from 15 different countries and one for Europe as a whole. All guidelines focused on the management of patients with low back pain in a primary care or multidisciplinary care setting. Five guidelines presented red flags in general, i.e., not related to any specific disease. Overall, we found 46 discrete red flags related to the four main categories of serious pathology: malignancy, fracture, cauda equina syndrome and infection. The majority of guidelines presented two red flags for fracture ('major or significant trauma' and 'use of steroids or immunosuppressors') and two for malignancy ('history of cancer' and 'unintentional weight loss'). Most often pain at night or at rest was also considered as a red flag for various underlying pathologies. Eight guidelines based their choice of red flags on consensus or previous guidelines; five did not provide any reference to support the choice of red flags, three guidelines presented a reference in general, and data on diagnostic accuracy was rarely provided. CONCLUSION: A wide variety of red flags was presented in guidelines for low back pain, with a lack of consensus between guidelines for which red flags to endorse. Evidence for the accuracy of recommended red flags was lacking.

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http://hdl.handle.net/10453/158992