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Self‐reported prognostic factors in adults reporting neck or low back pain: An umbrella review

Mansell, Gemma; Corp, Nadia; Wynne-Jones, Gwenllian; Hill, Jonathan; Stynes, Siobhán; van der Windt, Daniëlle

Self‐reported prognostic factors in adults reporting neck or low back pain: An umbrella review Thumbnail


Gemma Mansell


Numerous systematic reviews have attempted to synthesise evidence on prognostic factors for predicting future outcomes such as pain, disability and return-to-work/work absence in neck and low back pain populations. An umbrella review of systematic reviews was conducted to summarise the magnitude and quality of the evidence for each prognostic factor investigated. Searches were limited to the last 10 years (2008-11th April 2018, updated 28th September 2020). A two-stage approach was undertaken: in stage one, data on prognostic factors was extracted from systematic reviews identified from the systematic search that met the inclusion criteria. Where a prognostic factor was investigated in =1 systematic review and where 50% or more of those reviews found an association between the prognostic factor and one of the outcomes of interest, it was taken forward to stage two. In stage two, additional information extracted included the strength of association found, consistency of effects, and risk of bias. The GRADE approach was used to grade confidence in the evidence. Stage one identified 41 reviews (90 prognostic factors), with 35 reviews (25 prognostic factors) taken forward to stage two. Seven prognostic factors (disability/activity limitation, mental health; pain intensity; pain severity; coping; expectation of outcome/recovery; and fear-avoidance) were judged as having moderate confidence for robust findings. Although there was conflicting evidence for the strength of association with outcome, these factors may be used for identifying vulnerable subgroups or people able to self-manage. Further research can investigate the impact of using such prognostic information on treatment/referral decisions and patient outcomes.

Journal Article Type Review
Acceptance Date Apr 9, 2021
Online Publication Date May 2, 2021
Publication Date 2021-09
Publicly Available Date May 30, 2023
Journal European Journal of Pain
Print ISSN 1090-3801
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 25
Issue 8
Pages 1627-1643
Keywords Anesthesiology and Pain Medicine
Publisher URL