SynthesisBMC musculoskeletal disorders2017
Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews.
Synthesis in BMC musculoskeletal disorders, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 71 papers, 2 of them syntheses that pooled 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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
71 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Utility of minimally invasive percutaneous arthrodesis of the sacroiliac joint for the treatment of low back pain: systematic review of the literature.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 · 2025Pooled it
- Spinopelvic fixation failure in the adult spinal deformity population: systematic review and meta-analysis.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 · 2024Pooled it
- The Added Value of Face-to-Face Supervision to a Therapeutic Exercise-Based App in the Management of Patients with Chronic Low Back Pain: A Randomized Clinical Trial.Sensors (Basel, Switzerland) · 2024Trial
- Effects of spinal manipulation or mobilization as an adjunct to neurodynamic mobilization for lumbar disc herniation with radiculopathy: a randomized clinical trial.The Journal of manual & manipulative therapy · 2023Trial
- Age-Related Transitions in Low Back Pain Pathology: A Life-Course Narrative Review.Pain and therapy · 2026Review
- Interventional radiology management of disc herniation: a narrative review.La Radiologia medica · 2026Review
- Effectiveness of Opioids for Low Back Pain: A Systematic Review of Randomised Controlled Trials.Cureus · 2026Review
- Radiomics and Back Pain.Global spine journal · 2026Review
- fNIRS as a Biomarker for Preoperative Assessment: Correlating Brain Activity with Clinical Evaluation for Lumbar Disc Herniation.Bioengineering (Basel, Switzerland) · 2026Article
- Expert Consensus-Based Criteria for Identifying Lumbar Facet Joint Pain in Primary Care: Development Using Factor Analysis and a Modified Delphi Method.Pain and therapy · 2026Article
- Assessment of central pain sensitization in chronic low back pain and its utility in diagnosis and prediction of clinical severity.Scientific reports · 2026Article
- Differential Diagnosis of Posterior Buttock Pain: A Conceptual Review Based on Topographic Localization of Pain, Is It Really the Sacroiliac Joint?International journal of spine surgery · 2025Article
- Challenges and opportunities for omics-based precision medicine in chronic low back pain.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 · 2025Review
- Hamstring Myometric Properties and the Functional Outcome in Young Adults with Radicular Pain: A Cross-Sectional Study.Journal of human kinetics · 2025Article
- Prevalence of Myofascial Trigger Points in Patients with Radiating and Non-Radiating Low Back Pain: A Systematic Review.Biomedicines · 2025Review
- Musculoskeletal mimics of lumbosacral radiculopathy.Muscle & nerve · 2025Review
- circ_0000389 inhibits intervertebral disc degeneration by targeting the miR-346/KLF7 axis.Acta biochimica et biophysica Sinica · 2025Article
- Surgical and non-surgical management of spondylolisthesis: a comprehensive review.Journal of medicine and life · 2025Review
- Surgical Stabilization of the Spine: A Clinical Review of Spinal Fractures, Spondylolisthesis, and Instrumentation Methods.Journal of clinical medicine · 2025Review
- Is the Central Sensitization in Chronic Nonspecific Low Back Pain Structural Phenomenon or Psychological Reaction? A Narrative Review.Journal of clinical medicine · 2025Review
11 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundClinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization.
methodsA sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR.
resultsSixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making.
conclusionsThis is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed.
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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.