Evidence map›Paper›PMID 27376890›Full record

ReviewEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2016

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

Arianne P Verhagen, Aron Downie, Nahid Popal, Chris Maher, Bart W Koes

Registry-linked trialOpen access · hybridAbstract readReview
PubMed Publisher
In one paragraph

Review in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06148896 (Effects of Combining Physiotherapy Group Exercise With Acceptance and Commitment Therapy in Elderly With Chronic Nonspecific Low Back Pain), which is not on this map. Cited by 75 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
75citing papers in PubMed, 4 pooled it
13.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06148896 naunknown statusnot on this mapstarted 2023, after this paper: background citation

Effects of Combining Physiotherapy Group Exercise With Acceptance and Commitment Therapy in Elderly With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial

TypeinterventionalSponsorThe Hong Kong Polytechnic UniversityRan2023 to 2024Enrolled86ConditionsChronic Low Back PainArmsGrExPACT, GrEx
3 · Its place in the literature

Who cites it

75 citing papers in PubMed, 4 syntheses or guidelines pooled it, 203 citations in OpenAlex.

  1. Pooled it
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  13. Observational
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15 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Arianne P VerhagenDepartment of General Practice, Erasmus Medical Centre University, PO box 2040, 3000 CA, Rotterdam, The Netherlands. a.verhagen@erasmusmc.nl.
Aron DownieThe George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
Nahid PopalDepartment of General Practice, Erasmus Medical Centre University, PO box 2040, 3000 CA, Rotterdam, The Netherlands.
Chris MaherThe George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
Bart W KoesDepartment of General Practice, Erasmus Medical Centre University, PO box 2040, 3000 CA, Rotterdam, The Netherlands.
University of Sydney · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe 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.

methodWe 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.

resultsWe 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.

conclusionA 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.

Indexed as

Practice Guidelines as TopicAortic AneurysmBone Diseases, InfectiousHumansLow Back PainPrimary Health CareSpinal FracturesSpinal NeoplasmsLow back painPractice guidelines/clinical guidelines

Identifiers

PMID27376890
OpenAlexW2474151685

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.