Hill Charles James, Banerjee Anirban, Hill Jonathan, Stapleton Claire
University of Keele, Newcastle under Lyme, UK.
Musculoskeletal Care. 2023 Dec;21(4):1482-1496. doi: 10.1002/msc.1816. Epub 2023 Oct 9.
Low back pain (LBP) is a common complex condition, where specific diagnoses are hard to identify. Diagnostic clinical prediction rules (CPRs) are known to improve clinical decision-making. A review of LBP diagnostic-CPRs by Haskins et al. (2015) identified six diagnostic-CPRs in derivation phases of development, with one tool ready for implementation. Recent progress on these tools is unknown. Therefore, this review aimed to investigate developments in LBP diagnostic-CPRs and evaluate their readiness for implementation.
A systematic review was performed on five databases (Medline, Amed, Cochrane Library, PsycInfo, and CINAHL) combined with hand-searching and citation-tracking to identify eligible studies. Study and tool quality were appraised for risk of bias (Quality Assessment of Diagnostic Accuracy Studies-2), methodological quality (checklist using accepted CPR methodological standards), and CPR tool appraisal (GRade and ASsess Predictive).
Of 5021 studies screened, 11 diagnostic-CPRs were identified. Of the six previously known, three have been externally validated but not yet undergone impact analysis. Five new tools have been identified since Haskin et al. (2015); all are still in derivation stages. The most validated diagnostic-CPRs include the Lumbar-Spinal-Stenosis-Self-Administered-Self-Reported-History-Questionnaire and Diagnosis-Support-Tool-to-Identify-Lumbar-Spinal-Stenosis, and the StEP-tool which differentiates radicular from axial-LBP.
This updated review of LBP diagnostic CPRs found five new tools, all in the early stages of development. Three previously known tools have now been externally validated but should be used with caution until impact evaluation studies are undertaken. Future funding should focus on externally validating and assessing the impact of existing CPRs on clinical decision-making.
腰痛（LBP）是一种常见的复杂病症，难以做出明确诊断。已知诊断性临床预测规则（CPRs）有助于改善临床决策。Haskins等人（2015年）对LBP诊断性CPRs的综述确定了处于开发推导阶段的六种诊断性CPRs，其中一种工具已准备好实施。这些工具的最新进展尚不清楚。因此，本综述旨在调查LBP诊断性CPRs的发展情况，并评估其实施的准备程度。
对五个数据库（Medline、Amed、Cochrane图书馆、PsycInfo和CINAHL）进行系统综述，并结合手工检索和引文跟踪以确定符合条件的研究。对研究和工具质量进行偏倚风险评估（诊断准确性研究质量评估-2）、方法学质量评估（使用公认的CPR方法标准清单）以及CPR工具评估（分级和评估预测性）。
在筛选的5021项研究中，确定了11种诊断性CPRs。在之前已知的六种中，三种已进行外部验证，但尚未进行影响分析。自Haskin等人（2015年）以来，已确定了五种新工具；所有这些工具仍处于推导阶段。验证程度最高的诊断性CPRs包括腰椎管狭窄症自我管理自我报告病史问卷和识别腰椎管狭窄症的诊断支持工具，以及区分神经根性与轴性腰痛的StEP工具。
本次对LBP诊断性CPRs的更新综述发现了五种新工具，均处于开发早期阶段。三种先前已知的工具现已进行外部验证，但在进行影响评估研究之前应谨慎使用。未来的资金应集中于对现有CPRs进行外部验证并评估其对临床决策的影响。
