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. 2012 May;20(2):59-65.
doi: 10.1179/2042618611Y.0000000025.

A literature review reveals that trials evaluating treatment of non-specific low back pain use inconsistent criteria to identify serious pathologies and nerve root involvement

Ciaran Williams  1 , Mark J Hancock, Manuela Ferreira, Paulo Ferreira, Chris G Maher
Affiliations

A literature review reveals that trials evaluating treatment of non-specific low back pain use inconsistent criteria to identify serious pathologies and nerve root involvement

Ciaran Williams et al. J Man Manip Ther. 2012 May.

Abstract

Objectives: The broad aim of this study was to assess the homogeneity of patients included in trials of non-specific low back pain (NSLBP). To do this, we investigated the consistency and clarity of criteria used to identify and exclude participants with serious pathologies and nerve root compromise in randomized controlled trials, investigating interventions for NSLBP.

Methods: We searched Medline database for randomized controlled trials of low back pain (LBP). published between 2000 and 2009. We then randomly selected and screened trials for inclusion until we had 50 eligible trials. Data were extracted on the criteria used to identify cases of serious conditions (e.g. cancer, fracture) and nerve root involvement.

Results: The majority of papers (35/50) explicitly excluded patients with serious pathology. However, the terminology used and examples given were highly variable. Nerve root involvement was an exclusion criterion in the majority but not all studies. The criteria used for excluding patients with nerve root involvement varied greatly between studies. The most common criteria were 'motor, sensory or reflex changes' (nine studies), followed by 'pain radiating below the knee' (five studies) and 'reduced straight leg raise which reproduces leg pain' (five studies). In half of the included studies, the criteria used, while alluding to nerve root involvement, were not explained adequately for us to determine the types of patients included or excluded.

Discussion: The inconsistent and unclear criteria used to identify cases of serious pathology and nerve root compromise means that published trials of LBP likely include heterogeneous patient populations. This trait limits our ability to make comparisons across trials or pool studies. Standardization and consensus is important for future research.

Keywords: Low back pain; Nerve root compromise; Red flags; Sciatica.

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Figures

Figure 1
Figure 1
Flow chart: study selection.
Figure 2
Figure 2
Criteria for exclusion of nerve root involvement (n = 50). α, motor, sensory, reflex changes; β, leg pain greater than back pain; χ, pain radiates below the knee; δ, reduced straight leg raise which reproduces pain.
See this image and copyright information in PMC

References

    1. Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19:2075–94 - PMC - PubMed
    1. Bekkering G, Hendriks H, Koes B, Oostendorp R, Ostelo R, Thomassen J, et al. Dutch physiotherapy guidelines for low back pain. Physiotherapy. 2003;89:82–96
    1. Luijsterburg PA, Verhagen AP, Ostelo RW, van Os TA, Peul WC, Koes BW. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J. 2007;16:881–99 - PMC - PubMed
    1. Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010;15:CD007612. - PubMed
    1. Bokov A, Skorodumov A, Isrelov A, Stupak Y, Kukarin A. Differential treatment of nerve root compression pain caused by lumbar disc herniation applying nucleoplasty. Pain Phys. 2010;13:469–80 - PubMed

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