Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands.
Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands.
J Pain. 2021 Dec;22(12):1545-1559. doi: 10.1016/j.jpain.2021.04.013. Epub 2021 May 23.
It is widely accepted that psychosocial prognostic factors should be addressed by clinicians in their assessment and management of patient suffering from low back pain (LBP). On the other hand, an overview is missing how these factors are addressed in clinical LBP guidelines. Therefore, our objective was to summarize and compare recommendations regarding the assessment and management of psychosocial prognostic factors for LBP chronicity, as reported in clinical LBP guidelines. We performed a systematic search of clinical LBP guidelines (PROSPERO registration number 154730). This search consisted of a combination of previously published systematic review articles and a new systematic search in medical or guideline-related databases. From the included guidelines, we extracted recommendations regarding the assessment and management of LBP which addressed psychosocial prognostic factors (ie, psychological factors ["yellow flags"], perceptions about the relationship between work and health, ["blue flags"], system or contextual obstacles ["black flags") and psychiatric symptoms ["orange flags"]). In addition, we evaluated the level or quality of evidence of these recommendations. In total, we included 15 guidelines. Psychosocial prognostic factors were addressed in 13 of 15 guidelines regarding their assessment and in 14 of 15 guidelines regarding their management. Recommendations addressing psychosocial factors almost exclusively concerned "yellow" or "black flags," and varied widely across guidelines. The supporting evidence was generally of very low quality. We conclude that in general, clinical LBP guidelines do not provide clinicians with clear instructions about how to incorporate psychosocial factors in LBP care and should be optimized in this respect. More specifically, clinical guidelines vary widely in whether and how they address psychosocial factors, and recommendations regarding these factors generally require better evidence support. This emphasizes a need for a stronger evidence-base underlying the role of psychosocial risk factors within LBP care, and a need for uniformity in methodology and terminology across guidelines. PERSPECTIVE: This systematic review summarized clinical guidelines on low back pain (LBP) on how they addressed the identification and management of psychosocial factors. This review revealed a large amount of variety across guidelines in whether and how psychosocial factors were addressed. Moreover, recommendations generally lacked details and were based on low quality evidence.
人们普遍认为，临床医生在评估和治疗腰痛（LBP）患者时应考虑心理社会预后因素。另一方面，目前缺乏对临床 LBP 指南中如何处理这些因素的概述。因此，我们的目的是总结和比较临床 LBP 指南中报告的关于评估和管理 LBP 慢性的心理社会预后因素的建议。我们对临床 LBP 指南进行了系统检索（PROSPERO 注册号 154730）。该检索包括之前发表的系统评价文章的组合以及在医学或指南相关数据库中的新系统检索。从纳入的指南中，我们提取了关于评估和管理 LBP 的建议，这些建议涉及心理社会预后因素（即心理因素 ["黄色标志"]、对工作与健康关系的看法 ["蓝色标志"]、系统或环境障碍 ["黑色标志"] 和精神症状 ["橙色标志"]）。此外，我们还评估了这些建议的证据水平或质量。总共纳入了 15 项指南。在 15 项指南中有 13 项指南涉及心理社会预后因素的评估，14 项指南涉及心理社会预后因素的管理。针对心理社会因素的建议几乎只涉及“黄色”或“黑色标志”，并且在不同指南之间差异很大。支持证据通常质量非常低。我们的结论是，一般来说，临床 LBP 指南并没有为临床医生提供关于如何将心理社会因素纳入 LBP 护理的明确指导，在这方面应该进行优化。更具体地说，临床指南在是否以及如何处理心理社会因素方面差异很大，并且针对这些因素的建议通常需要更好的证据支持。这强调了在 LBP 护理中需要一个更强的心理社会危险因素作用的证据基础，并且需要在指南之间实现方法和术语的统一。观点：本系统评价总结了关于如何识别和管理心理社会因素的临床腰痛（LBP）指南。本综述显示，指南在是否以及如何处理心理社会因素方面存在很大差异。此外，建议通常缺乏细节，并且基于低质量的证据。
