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Red flags in low back pain

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https://www.readbyqxmd.com/read/29232762/review-article-best-practice-management-of-low-back-pain-in-the-emergency-department-part-1-of-the-musculoskeletal-injuries-rapid-review-series
#1
REVIEW
Kirsten Strudwick, Megan McPhee, Anthony Bell, Melinda Martin-Khan, Trevor Russell
Low back pain (LBP) is a common presentation to the ED, and a frequent cause of disability globally. The ED management is often associated with high rates of imaging, misuse and overuse of pharmacology and subsequent financial implications. Given this, improved quality of care for patients with LBP in ED is essential. This rapid review investigated best practice for the assessment and management of LBP in the ED. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2015...
December 12, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29201820/clinical-usefulness-of-x-ray-findings-for-non-specific-low-back-pain-in-korean-farmers-farm-study
#2
Eun Kyoung Kang, Hee-Won Park, Sung Hyun Kim, Sora Baek
Objective: To elucidate the association between non-specific low back pain (NSLBP) and spinal X-ray findings in Korean farmers: Farmers' Cohort for Agricultural Work-Related Musculoskeletal disorders (FARM) study. Methods: A total of 835 farmers (391 males, 444 females; mean age, 56.6±7.4 years) without red-flag signs of specific LBP were recruited. Presence of LBP more than one week or once a month with more than moderate degree of pain severity during the last year was assessed with a binary questionnaire (yes or no)...
October 2017: Annals of Rehabilitation Medicine
https://www.readbyqxmd.com/read/29144110/effect-of-stabilization-exercise-on-back-pain-disability-and-quality-of-life-in-adult-with-scoliosis-a-systematic-review
#3
Malik H Alanazi, Eric C Parent, Elizabeth Dennett
INTRODUCTION: Adult Scoliosis (AS) is the most common spine deformity in adults. Back pain is the main symptom leading patients to seek medical consultation. Stabilization exercise has been shown effective for reducing back pain. No literature review has examined the effects of such exercises in adults with scoliosis. OBJECTIVES: To systematically review the effects of stabilization exercises on back pain, disability and quality of life in adults with scoliosis...
November 16, 2017: European Journal of Physical and Rehabilitation Medicine
https://www.readbyqxmd.com/read/29097953/a-young-female-athlete-with-acute-low-back-pain-caused-by-stage-iv-breast-cancer
#4
Evan A Kahn
Objective: The purpose of this case report is to describe the case of a young female athlete with low back pain caused by metastatic breast cancer. Clinical Features: A 27-year-old woman presented with low back pain after striking a ball during kickball 3 days earlier. Because of the mechanism of injury and onset, the patient was originally diagnosed with a lumbar spine sprain/strain. Intervention/Outcome: After radiographs were obtained and were read as unremarkable, a 2-week trial of care was initiated that included soft-tissue mobilizations, anti-inflammatory medications from her primary care physician, and therapeutic rehabilitation exercises...
September 2017: Journal of Chiropractic Medicine
https://www.readbyqxmd.com/read/28923844/red-flag-screening-for-low-back-pain-nothing-to-see-here-move-along-a-narrative-review
#5
REVIEW
Chad E Cook, Steven Z George, Michael P Reiman
Screening for red flags in individuals with low back pain (LBP) has been a historical hallmark of musculoskeletal management. Red flag screening is endorsed by most LBP clinical practice guidelines, despite a lack of support for their diagnostic capacity. We share four major reasons why red flag screening is not consistent with best practice in LBP management: (1) clinicians do not actually screen for red flags, they manage the findings; (2) red flag symptomology negates the utility of clinical findings; (3) the tests lack the negative likelihood ratio to serve as a screen; and (4) clinical practice guidelines do not include specific processes that aid decision-making...
September 18, 2017: British Journal of Sports Medicine
https://www.readbyqxmd.com/read/28798035/red-flags-or-red-herrings-redefining-the-role-of-red-flags-in-low-back-pain-to-reduce-overimaging
#6
EDITORIAL
Gilat L Grunau, Ben Darlow, Timothy Flynn, Kieran O'Sullivan, Peter B O'Sullivan, Bruce B Forster
No abstract text is available yet for this article.
August 10, 2017: British Journal of Sports Medicine
https://www.readbyqxmd.com/read/28727922/considerations-in-physical-therapy-management-of-a-non-responding-patient-with-low-back-pain
#7
Timothy J Madson
STUDY DESIGN: Case Study. BACKGROUND AND PURPOSE: Low back pain is a common condition managed by physical therapists (PT). Screening tools have been developed to assist the PT with medical screening of patients for serious disease. Sinister pathologies may present as musculoskeletal symptoms during the patient examination. It is important for the PT to frequently reevaluate their patient's response to therapeutic interventions and refer for further evaluation if they are not responding to conservative care...
July 20, 2017: Physiotherapy Theory and Practice
https://www.readbyqxmd.com/read/28708761/most-red-flags-for-malignancy-in-low-back-pain-guidelines-lack-empirical-support-a-systematic-review
#8
Arianne P Verhagen, Aron Downie, Chris G Maher, Bart W Koes
Clinicians do not want to miss underlying serious pathology, but it is still unclear which red flags are relevant. We aimed to evaluate the origin and evidence on diagnostic accuracy of red flags for malignancy for management of low back pain (LBP) in primary care. We performed a comprehensive overview and searched the literature using snowballing techniques and reference checking for evidence on red flags endorsed in clinical guidelines for identifying patients with higher likelihood of malignancy. We selected studies including people with LBP without any restriction on study design...
October 2017: Pain
https://www.readbyqxmd.com/read/28505161/effect-on-healthcare-utilization-and-costs-of-spinal-manual-therapy-for-acute-low-back-pain-in-routine-care-a-propensity-score-matched-cohort-study
#9
Jochen Walker, Ulf Kai Mertens, Carsten Oliver Schmidt, Jean-François Chenot
Spinal manual therapy (SMT) is a popular treatment option for low back pain (LBP). The aim of our analysis was to evaluate the effects of manual therapy delivered by general practitioners and ambulatory orthopedic surgeons in routine care on follow up consultations, sick leave, health service utilization and costs for acute LBP compared to matched patients not receiving manual therapy. This is a propensity score matched cohort study based on health claims data. We identified a total of 113.652 adult patients with acute LBP and no coded red flags of whom 21...
2017: PloS One
https://www.readbyqxmd.com/read/28483544/clinical-decision-support-decreases-volume-of-imaging-for-low-back-pain-in-an%C3%A2-urban-emergency-department
#10
Adam Min, Vivian W Y Chan, Ruben Aristizabal, Ed R Peramaki, David B Agulnik, Nardia Strydom, Damon Ramsey, Bruce B Forster
PURPOSE: To determine whether point-of-care clinical decision support can effectively reduce inappropriate medical imaging of patients who present to the emergency department (ED) with low-back pain (LBP). MATERIALS AND METHODS: This was a prospective, single-center study of lumbar imaging referrals made by 43 emergency physicians at a major acute care center. Each physician saw at least 10 LBP cases in both pre- and post-intervention periods. A point-of-care checklist of accepted red flags for LBP was designed by a working group of physicians and embedded in the computerized order entry form for lumbar imaging...
July 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28399548/adherence-to-back-pain-clinical-practice-guidelines-by-brazilian-physical-therapists-a-cross-sectional-study
#11
Fabrício S de Souza, Carlos E Ladeira, Leonardo O P Costa
STUDY DESIGN: This was a cross-sectional observational study. OBJECTIVES: (i) to investigate whether Brazilian physical therapists make clinical decisions for patients with low back pain based upon clinical practice guidelines and (ii) to determine whether the physical therapists are able to recognize differential diagnoses of low back pain associated with red or yellow flags. SUMMARY OF BACKGROUND DATA: Early adherence to clinical practice guidelines may accelerate recovery and reduce the costs associated with low back pain...
November 1, 2017: Spine
https://www.readbyqxmd.com/read/28375914/low-back-pain
#12
Jinny O Tavee, Kerry H Levin
PURPOSE OF REVIEW: This article provides an overview of evaluating and treating low back pain in the outpatient setting. RECENT FINDINGS: As most cases of acute low back pain have a favorable prognosis, current guidelines on imaging studies recommend conservative treatment for 6 weeks prior to obtaining an MRI if no red flags are present. Of these red flags, a prior history of cancer is the strongest risk factor for a malignant etiology and requires urgent evaluation with MRI...
April 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28251880/choosing-wisely-canada%C3%A2-five-tests-procedures-and-treatments-to-question-in-emergency-medicine
#13
Amy H Y Cheng, Sam Campbell, Lucas B Chartier, Tom Goddard, Kirk Magee, Jill McEwen, Atul K Kapur, Brian R Holroyd, Suneel Upadhye, Stephanie Couperthwaite, Brian H Rowe
OBJECTIVES: Choosing Wisely Canada (CWC) is an initiative to encourage patient-physician discussions about the appropriate, evidence based use of medical tests, procedures and treatments. We present the Canadian Association of Emergency Physicians' (CAEP) top five list of recommendations, and the process undertaken to generate them. METHODS: The CAEP Expert Working Group (EWG) generated a candidate list of 52 tests, procedures, and treatments in emergency medicine whose value to care was questioned...
March 2, 2017: CJEM
https://www.readbyqxmd.com/read/27496288/acr-appropriateness-criteria-low-back%C3%A2-pain
#14
Nandini D Patel, Daniel F Broderick, Judah Burns, Tejaswini K Deshmukh, Ian Blair Fries, H Benjamin Harvey, Langston Holly, Christopher H Hunt, Bharathi D Jagadeesan, Tabassum A Kennedy, John E O'Toole, Joel S Perlmutter, Bruno Policeni, Joshua M Rosenow, Jason W Schroeder, Matthew T Whitehead, Rebecca S Cornelius, Amanda S Corey
Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP...
September 2016: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/27376890/red-flags-presented-in-current-low-back-pain-guidelines-a-review
#15
Arianne P Verhagen, Aron Downie, Nahid Popal, Chris Maher, Bart W Koes
OBJECTIVE: The purpose of this study was to identify and descriptively compare the red flags endorsed in guidelines for the detection of serious pathology in patients presenting with low back pain to primary care. METHOD: We searched databases, the World Wide Web and contacted experts aiming to find the multidisciplinary clinical guideline in low back pain in primary care, and selected the most recent one per country. We extracted data on the number and type of red flags for identifying patients with higher likelihood of serious pathology...
September 2016: European Spine Journal
https://www.readbyqxmd.com/read/27352276/imaging-of-degenerative-and-infectious-conditions-of-the-spine
#16
REVIEW
Lubdha M Shah, Jeffrey S Ross
UNLABELLED: : Imaging is important in the evaluation of patients with degenerative disease and infectious processes. There are numerous conditions that can manifest as low back pain (LBP) or neck pain in a patient, and in many cases, the cause may be multifactorial. Clinical history and physical examination are key components in the evaluation of such patients; however, physical examination has variable sensitivity and specificity. Although studies have demonstrated that uncomplicated acute LBP and/or radiculopathy are self-limited conditions that do not warrant any imaging, neuroimaging can provide clear anatomic delineation of potential causes of the patient's clinical presentation...
September 2016: Neurosurgery
https://www.readbyqxmd.com/read/27270641/cost-effectiveness-of-primary-care-management-with-or-without-early-physical-therapy-for-acute-low-back-pain-economic-evaluation-of-a-randomized-clinical-trial
#17
Julie M Fritz, Minchul Kim, John S Magel, Carl V Asche
STUDY DESIGN: Economic evaluation of a randomized clinical trial. OBJECTIVE: Compare costs and cost-effectiveness of usual primary care management for patients with acute low back pain (LBP) with or without the addition of early physical therapy. SUMMARY OF BACKGROUND DATA: Low back pain is among the most common and costly conditions encountered in primary care. Early physical therapy after a new primary care consultation for acute LBP results in small clinical improvement but cost-effectiveness of a strategy of early physical therapy is unknown...
March 2017: Spine
https://www.readbyqxmd.com/read/27187219/management-of-acute-lumbar-injuries-in-the-workplace
#18
Ann Regina Lurati
Occupational acute lumbar injuries are a common injury. One intervention that is unique to occupational health is the determination of the amount of physical activity that an injured worker can perform without increasing the risk of further injury. Clinical recommendations suggest that workers continue to stay active; however, it is still the clinician's responsibility to determine the level of activity. The level of work activity is determined on a case-to-case basis and is done by evaluating the physical capacity of an injured worker and the job description...
May 2016: Orthopaedic Nursing
https://www.readbyqxmd.com/read/27167551/initial-approach-to-patients-with-acute-lower-back-pain
#19
REVIEW
Andrei Fernandes Joaquim
Low back pain is in one of the most common reasons for seeking medical care in emergency care units, and also the second most common cause of work absenteeism. The recognition of red flags for serious diseases such as tumors and fractures, through proper history-taking and clinical examination, is essential for proper treatment and to rule out differential diagnoses. In the absence of suspected severe underlying disease, subsidiary radiological examinations are unnecessary. Analgesic and anti-inflammatory drugs are the treatment of choice and can be cautiously associated with muscle relaxants and opioids in more severe cases...
April 2016: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/27120496/acute-lumbar-back-pain
#20
Hans-Raimund Casser, Susann Seddigh, Michael Rauschmann
BACKGROUND: Back pain has many causes. In Germany, about 70% of adults have at least one episode of back pain per year. METHODS: This review is based on a selective literature search and on the German National Disease Management Guideline for Low Back Pain. RESULTS: The physician taking the history from a patient with back pain should ask about the nature, onset, course, localization, and radiation of the pain and its dependence on physical activity and/or emotional stress...
April 1, 2016: Deutsches Ärzteblatt International
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