Evidence map›Paper›PMID 41258632›Full record

ArticleClinical rheumatology2026

Design and validation of a referral algorithm for inflammatory arthritis and low back pain: identifying gaps in primary care practices.

Nelly Ziade, Karen Mechleb, Chafika Haouichat, Fatemah Baron, Nizar Abdulateef Al-Ani, Asal Ridha Adnan, Lina El Kibbi, Manal Mashaleh, Bassel Elzorkany, Sherif M Gamal and 8 more

Erratum issuedAbstract readValidation Study
PubMed Publisher
In one paragraph

Article in Clinical rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
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

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors.

Nelly ZiadeDepartment of Rheumatology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Ville-Dieu Center, Jean-Dominique Ayoub Street, Achrafieh, Beirut, Lebanon. nelly.zoghbi@usj.edu.lb.ORCID http://orcid.org/0000-0002-4479-7678
Karen MechlebDepartment of Rheumatology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Ville-Dieu Center, Jean-Dominique Ayoub Street, Achrafieh, Beirut, Lebanon.
Chafika HaouichatRheumatology Department, Djillali Bounaama University Hospital, Douera, Algiers, Algeria.
Fatemah BaronInternal Medicine Department, Unit of Rheumatology, Ministry of Health, Al-Jahra Hospital, Kuwait City, Kuwait.
Nizar Abdulateef Al-AniDepartment of Medicine, Rheumatology Unit, University of Baghdad, Baghdad, Iraq.
Asal Ridha AdnanDepartment of Medicine, Rheumatology Unit, University of Baghdad, Baghdad, Iraq.
Lina El KibbiDepartment of Internal Medicine, Division of Rheumatology, Specialized Medical Center, Riyadh, Saudi Arabia.
Manal MashalehRheumatology Division of Internal Medicine, Saudi Hospital Clinics, Amman, Jordan.
Bassel ElzorkanyRheumatology Department, Cairo University, Cairo, Egypt.
Sherif M GamalRheumatology Department, Cairo University, Cairo, Egypt.
Avin MaroofSchool of Medicine, University of Kurdistan Hawlêr, Erbil, Iraq.
Manal El RakaawiFaculty of Medicine El Mahdi Si Ahmed, Blida, Algeria.
Fatima AlnaimatDepartment of Medicine, Division of Rheumatology, The University of Jordan, Amman, Jordan.
Mariam ErraouiDepartment of Rheumatology, Souss Massa University Hospital, Agadir, Morocco.
Krystel AouadDepartment of Internal Medicine, Division of Rheumatology, Saint George Hospital University Medical Center, Saint George University of Beirut, Beirut, Lebanon.
Basel MasriDepartment of Internal Medicine, Rheumatology Division, Jordan, Hospital and Medical Center , Amman, Jordan.
Ihsane HmamouchiFaculty of Medicine, Health Sciences Research Center (CReSS), International University of Rabat (UIR), Rabat, Morocco.
ArLAR research group – ARCH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTimely referral of patients with inflammatory arthritis (IA) and inflammatory low back pain to rheumatology is crucial. This study designed and validated a referral algorithm for non-rheumatologists in Arab countries and identified gaps in correct referrals and referral parameters.

methodsSixteen rheumatologists adopted referral algorithms, based on validation studies and clinical expertise, and summarized them in educational material (EM), including a PDF and video module. Five illustrative clinical vignettes were electronically sent to non-rheumatologists, to make referral decisions (phase 1). Two weeks later, the EM and the same vignettes were emailed again (phase 2). The primary outcome was the change in correct referral decisions using McNemar's test. Improvement in correct referral parameters was evaluated and factors associated with correct referrals were analysed using logistic binary multivariable analysis.

resultsEight hundred participants (general practitioners, family physicians, fellows, surgeons and others) from 13 countries completed phase 1 and 136 phase 2, with no demographic differences between them. Rates of phase 1 correct referral decisions were 72%, 72%, and 86% for referral-requiring cases, and 22% and 19% for others. In phase 2, correct referral decisions improved to 79%, 82%, and 88% for referral-requiring cases and 42% and 25% for others. Rates of most correct parameters improved significantly; factors associated with correct referrals included correct phase 1 referrals, duration of consultation, and fewer years practicing medicine.

conclusionMinor improvements in hypothetical referral decisions were observed after education, while significant improvements were noted for referral parameters. These results will help shape future referral campaigns' design. Key points • Inflammatory arthritis and low back pain referrals to rheumatologists need boosting. • The referral algorithm improved the rate of correct referral decisions. • The referral algorithm improved the rate of correct parameters guiding the decision.

Indexed as

AlgorithmsArthritisLow Back PainPrimary Health CareReferral and ConsultationAdultFemaleHumansMaleMiddle AgedRheumatologistsRheumatologyInflammatory arthritisPre- and post-test designReferral algorithmRheumatology referral

Identifiers

PMID41258632

What OpenQuestion holds

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Registered trials

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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.