Evidence map›Paper›PMID 33537911›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2021

ISSLS PRIZE IN CLINICAL SCIENCE 2021: What are the risk factors for low back pain flares and does this depend on how flare is defined?

Nathalia Costa, Esther Smits, Jessica Kasza, Sauro Salomoni, Manuela Ferreira, Michael Sullivan, Paul W Hodges

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In one paragraph

Article 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, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
2.6field-weighted citation impact, top 11% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. At the Intersection of Pain and Sleep: a Roadmap for Preclinical Pain Research.Frontiers in pain research (Lausanne, Switzerland) · 2025
    Review
  8. Article
  9. Article
  10. Review
  11. Article
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

7 authors at 4 institutions in 2 countries.

Nathalia CostaSchool of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
Esther SmitsThe University of Queensland, RECOVER Injury Research Centre, Brisbane, QLD, Australia.
Jessica KaszaMonash University, Melbourne, VIC, 4072, Australia.
Sauro SalomoniSchool of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
Manuela FerreiraInstitute of Bone and Joint Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, The Kolling Institute, Sydney, NSW, Australia.
Michael SullivanDepartment of Psychology, McGill University, Montreal, QC, Canada.
Paul W HodgesSchool of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia. p.hodges@uq.edu.au.ORCID http://orcid.org/0000-0002-1206-9107
The University of Queensland · AUMcGill University · CAMonash University · AUThe University of Sydney · AU

Funding

National Health and Medical Research Council (AU) APP1091302; APP1079078; APP1102905National Health and Medical Research Council (AU) APP1143593
6 · The paper itself

Abstract

purposeAlthough risk factors for new low back pain (LBP) episodes and acute-to-chronic transition have been identified, risk factors for flares of LBP remain largely unknown. This case-crossover study aimed to identify: (1) risk factors LBP flares and (2) whether risk factors differed when flare is defined by pain increase (pain-defined flare: PDF) or identified by participants according to a broader flare definition that considered emotions and coping (self-reported flare: SRF).

methodsOne hundred and twenty-six participants with LBP for > 3 months were included. Candidate risk factors and flares (PDF/SRF) were assessed daily using a smartphone application for 28 days. Data on exposure to risk factors one, two and three days preceding PDF/SRF were compared to control periods. Conditional logistic regression estimated associations between risk factors and PDF/SRF.

resultsOdds of PDF and SRF were increased by poor sleep quality and morning pain. Good sleep quality reduced odds of flare. Odds for increased pain (PDF), but not SRF, were increased after days with higher afternoon and evening pain, fatigue, fear of physical activity and leisure physical activity.

conclusionLBP flare has been largely ignored but is more reflective of the LBP experience than conventional definitions of acute, sub-acute and chronic LBP. This study highlights risk factors for flare and that these differ depending on whether flare is defined by pain alone (PDF) or a broad multidimensional definition (SRF). Potential targets to reduce the intensity/frequency of LBP flares are identified, with strong indication for the potential role of sleep intervention to mitigate LBP flare risk.

Indexed as

Awards and PrizesLow Back PainCross-Over StudiesHumansRisk FactorsSelf ReportFlaresLow back painRisk factorsTriggers

Identifiers

PMID33537911
OpenAlexW3126439595

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.