Recent highlights in low back pain research, Part I: Diagnosis and Prognosis

IF 9.4 1区医学 Q1 ORTHOPEDICS

Journal of Physiotherapy Pub Date : 2026-01-01 Epub Date: 2025-12-20 DOI:10.1016/j.jphys.2025.12.002

Rafael Zambelli Pinto , Alice Kongsted , Samuel Silva , Jill A Hayden , Aron Downie , Bruno T Saragiotto

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引用次数: 0

Abstract

Introduction

This paper highlights research relating to diagnosis and prognosis in low back pain (LBP) published between January 2020 and September 2025.

Methods

To identify studies for inclusion, we searched Medline, CINAHL and the Cochrane Database of Systematic Reviews. Search results were screened and relevant studies were grouped according to their topic area. From those results, we selected studies that were perceived to be of great clinical importance, particularly high quality and/or controversial.

Findings

This narrative review synthesised five key themes in LBP research. For Theme 1 (Serious pathologies presenting as LBP), we found that serious spinal conditions are rare, and clinicians should assess overall concern using a combination of alerting features rather than isolated red flags. In Theme 2 (Imaging in LBP management), we discussed the limited role of imaging, noting its continued overuse and frequent inappropriate application. In Theme 3 (Diagnostic uncertainty), we highlighted that LBP often lacks a clear anatomical cause and that embracing uncertainty while focusing on modifiable factors can help patients feel more supported and in control. Theme 4 (Clinical course and pain trajectories) showed that although recovery is common in recent onset LBP, recurrences are frequent; even long-lasting pain can improve. Traditional labels such as ‘acute’ and ‘chronic’ often fail to capture the fluctuating nature of LBP. Finally, in Theme 5 (Prognostic factors and prediction models), we presented patient characteristics related to delayed recovery but highlighted that current prediction models are not yet ready for clinical implementation. We provided direction for future research across all themes. The identified themes help clinicians make informed, evidence-based decisions and navigate current uncertainties in diagnosis and prognosis.

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最近腰痛研究的亮点，第一部分：诊断和预后。

本文重点介绍了2020年1月至2025年9月期间发表的与腰痛（LBP）诊断和预后相关的研究。方法：为了确定纳入的研究，我们检索了Medline、CINAHL和Cochrane系统评价数据库。对搜索结果进行筛选，并根据其主题领域对相关研究进行分组。从这些结果中，我们选择了被认为具有重要临床意义的研究，特别是高质量和/或有争议的研究。研究结果：这篇叙述性综述综合了LBP研究中的五个关键主题。对于主题1（以腰痛为表现的严重病理），我们发现严重的脊柱疾病是罕见的，临床医生应该使用警报特征的组合来评估整体关注，而不是孤立的危险信号。在主题2 （LBP管理中的成像）中，我们讨论了成像的有限作用，注意到它的持续过度使用和频繁的不适当应用。在主题3（诊断不确定性）中，我们强调了下腰痛通常缺乏明确的解剖学原因，在关注可改变因素的同时接受不确定性可以帮助患者获得更多支持和控制。主题4（临床过程和疼痛轨迹）表明，虽然最近发作的腰痛恢复很常见，但复发也很频繁；即使是长期的疼痛也可以改善。传统的标签，如“急性”和“慢性”往往不能捕捉到腰痛的波动性质。最后，在主题5（预后因素和预测模型）中，我们介绍了与延迟恢复相关的患者特征，但强调当前的预测模型尚未准备好用于临床实施。我们为所有主题的未来研究提供了方向。确定的主题有助于临床医生做出明智的、基于证据的决定，并在诊断和预后中导航当前的不确定性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Physiotherapy ORTHOPEDICS-REHABILITATION

CiteScore

11.40

自引率

7.40%

发文量

审稿时长

72 days

期刊介绍： The Journal of Physiotherapy is the official journal of the Australian Physiotherapy Association. It aims to publish high-quality research with a significant impact on global physiotherapy practice. The journal's vision is to lead the field in supporting clinicians to access, understand, and implement research evidence that will enhance person-centred care. In January 2008, the Journal of Physiotherapy became the first physiotherapy journal to adhere to the ICMJE requirement of registering randomized trials with a recognized Trial Registry. The journal prioritizes systematic reviews, clinical trials, economic analyses, experimental studies, qualitative studies, epidemiological studies, and observational studies. In January 2014, it also became the first core physiotherapy/physical therapy journal to provide free access to editorials and peer-reviewed original research. The Australian Physiotherapy Association extended their support for excellence in physiotherapy practice by sponsoring open access publication of all Journal of Physiotherapy content in 2016. As a result, all past, present, and future journal articles are freely accessible, and there are no author fees for publication.