Daniel Feller, Alessandro Chiarotto, Bart Koes, Filippo Maselli, Firas Mourad
{"title":"颈部疼痛患者潜在严重病理的危险信号:临床实践指南的系统回顾。","authors":"Daniel Feller, Alessandro Chiarotto, Bart Koes, Filippo Maselli, Firas Mourad","doi":"10.33393/aop.2024.3245","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>We conducted a systematic review of clinical practice guidelines to identify red flags for serious pathologies in neck pain mentioned in clinical practice guidelines, to evaluate agreement in red flag recommendations across guidelines, and to investigate the level of evidence including what study type the recommendations are based on.</p><p><strong>Methods: </strong>We searched for guidelines focusing on specific and nonspecific neck pain in MEDLINE, EMBASE, and PEDro up to June 9, 2023. Additionally, we searched for guidelines through citation tracking strategies, by consulting experts in the field, and by checking guideline organization databases.</p><p><strong>Results: </strong>We included 29 guidelines, 12 of which provided a total of 114 red flags for fracture (n = 17), cancer (n = 21), spinal infection (n = 14), myelopathy (n = 15), injury to the spinal cord (n = 1), artery dissection (n = 7), intracranial pathology (n = 3), inflammatory arthritis (n = 2), other systemic disease (n = 6), or unrelated to a specific condition (n = 19). Overall, there is very little agreement (median Fleiss' kappa of 0) between guidelines on the red flags to screen for serious pathologies.</p><p><strong>Conclusion: </strong>Red flags were mainly supported by expert opinions. We also observed a general lack of consensus among guidelines regarding which red flags to endorse. Considering the current limitations of the evidence, specific recommendations on which red flags to use cannot be provided, except for using the Canadian C-Spine rule for screening posttraumatic fractures.</p>","PeriodicalId":72290,"journal":{"name":"Archives of physiotherapy","volume":"14 ","pages":"105-115"},"PeriodicalIF":2.1000,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618059/pdf/","citationCount":"0","resultStr":"{\"title\":\"Red flags for potential serious pathologies in people with neck pain: a systematic review of clinical practice guidelines.\",\"authors\":\"Daniel Feller, Alessandro Chiarotto, Bart Koes, Filippo Maselli, Firas Mourad\",\"doi\":\"10.33393/aop.2024.3245\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>We conducted a systematic review of clinical practice guidelines to identify red flags for serious pathologies in neck pain mentioned in clinical practice guidelines, to evaluate agreement in red flag recommendations across guidelines, and to investigate the level of evidence including what study type the recommendations are based on.</p><p><strong>Methods: </strong>We searched for guidelines focusing on specific and nonspecific neck pain in MEDLINE, EMBASE, and PEDro up to June 9, 2023. Additionally, we searched for guidelines through citation tracking strategies, by consulting experts in the field, and by checking guideline organization databases.</p><p><strong>Results: </strong>We included 29 guidelines, 12 of which provided a total of 114 red flags for fracture (n = 17), cancer (n = 21), spinal infection (n = 14), myelopathy (n = 15), injury to the spinal cord (n = 1), artery dissection (n = 7), intracranial pathology (n = 3), inflammatory arthritis (n = 2), other systemic disease (n = 6), or unrelated to a specific condition (n = 19). Overall, there is very little agreement (median Fleiss' kappa of 0) between guidelines on the red flags to screen for serious pathologies.</p><p><strong>Conclusion: </strong>Red flags were mainly supported by expert opinions. We also observed a general lack of consensus among guidelines regarding which red flags to endorse. Considering the current limitations of the evidence, specific recommendations on which red flags to use cannot be provided, except for using the Canadian C-Spine rule for screening posttraumatic fractures.</p>\",\"PeriodicalId\":72290,\"journal\":{\"name\":\"Archives of physiotherapy\",\"volume\":\"14 \",\"pages\":\"105-115\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-12-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618059/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of physiotherapy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.33393/aop.2024.3245\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"REHABILITATION\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of physiotherapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.33393/aop.2024.3245","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"REHABILITATION","Score":null,"Total":0}
Red flags for potential serious pathologies in people with neck pain: a systematic review of clinical practice guidelines.
Introduction: We conducted a systematic review of clinical practice guidelines to identify red flags for serious pathologies in neck pain mentioned in clinical practice guidelines, to evaluate agreement in red flag recommendations across guidelines, and to investigate the level of evidence including what study type the recommendations are based on.
Methods: We searched for guidelines focusing on specific and nonspecific neck pain in MEDLINE, EMBASE, and PEDro up to June 9, 2023. Additionally, we searched for guidelines through citation tracking strategies, by consulting experts in the field, and by checking guideline organization databases.
Results: We included 29 guidelines, 12 of which provided a total of 114 red flags for fracture (n = 17), cancer (n = 21), spinal infection (n = 14), myelopathy (n = 15), injury to the spinal cord (n = 1), artery dissection (n = 7), intracranial pathology (n = 3), inflammatory arthritis (n = 2), other systemic disease (n = 6), or unrelated to a specific condition (n = 19). Overall, there is very little agreement (median Fleiss' kappa of 0) between guidelines on the red flags to screen for serious pathologies.
Conclusion: Red flags were mainly supported by expert opinions. We also observed a general lack of consensus among guidelines regarding which red flags to endorse. Considering the current limitations of the evidence, specific recommendations on which red flags to use cannot be provided, except for using the Canadian C-Spine rule for screening posttraumatic fractures.