临床医生在评估和管理患有下腰痛(LBP)的患者时应考虑心理社会预后因素,这是公认的。另一方面,在临床LBP指南中缺少如何解决这些因素的概述.因此,我们的目的是总结和比较关于慢性LBP心理社会预后因素评估和管理的建议,如临床LBP指南报道。我们对临床LBP指南(PROSPERO注册号154730)进行了系统搜索。该搜索由先前发表的系统评价文章和在医学或指南相关数据库中的新系统搜索组成。从包含的指导方针来看,我们提取了有关LBP评估和管理的建议,这些建议涉及心理社会预后因素(即,心理因素[“黄旗”],对工作和健康之间关系的看法,[\"蓝旗\"],系统或上下文障碍[\“黑旗”)和精神症状[\“橙色旗”])。此外,我们评估了这些建议的证据水平或质量.总的来说,我们纳入了15条指南。关于其评估的15个指南中的13个和关于其管理的15个指南中的14个都讨论了心理社会预后因素。解决社会心理因素的建议几乎只涉及“黄色”或“黑旗”,“并且在指南中差异很大。支持性证据通常质量很低。我们得出结论,总的来说,临床LBP指南没有为临床医生提供关于如何在LBP治疗中纳入心理社会因素的明确指导,因此应该在这方面进行优化.更具体地说,临床指南在是否以及如何解决社会心理因素方面差异很大,关于这些因素的建议通常需要更好的证据支持。这强调了在LBP护理中心理社会风险因素的作用基础上需要更强有力的证据基础。和需要统一的方法和术语跨准则。观点:本系统综述总结了下腰痛(LBP)的临床指南如何解决社会心理因素的识别和管理。这篇综述揭示了有关是否以及如何解决社会心理因素的各种指南。此外,建议通常缺乏细节,且基于低质量证据.
It is widely accepted that psychosocial prognostic factors should be addressed by clinicians in their assessment and management of patient suffering from low back pain (LBP). On the other hand, an overview is missing how these factors are addressed in clinical LBP
guidelines. Therefore, our objective was to summarize and compare recommendations regarding the assessment and management of psychosocial prognostic factors for LBP chronicity, as reported in clinical LBP guidelines. We performed a systematic search of clinical LBP guidelines (PROSPERO registration number 154730). This search consisted of a combination of previously published systematic review articles and a new systematic search in medical or
guideline-related databases. From the included guidelines, we extracted recommendations regarding the assessment and management of LBP which addressed psychosocial prognostic factors (ie, psychological factors [\"yellow flags\"], perceptions about the relationship between
work and health, [\"blue flags\"], system or contextual obstacles [\"black flags\") and psychiatric symptoms [\"orange flags\"]). In addition, we evaluated the level or quality of evidence of these recommendations. In total, we included 15
guidelines. Psychosocial prognostic factors were addressed in 13 of 15 guidelines regarding their assessment and in 14 of 15
guidelines regarding their management. Recommendations addressing psychosocial factors almost exclusively concerned \"yellow\" or \"black flags,\" and varied widely across guidelines. The supporting evidence was generally of very low quality. We conclude that in general, clinical LBP guidelines do not provide clinicians with clear instructions about how to incorporate psychosocial factors in LBP care and should be optimized in this respect. More specifically, clinical guidelines vary widely in whether and how they address psychosocial factors, and recommendations regarding these factors generally require better evidence support. This emphasizes a need for a stronger evidence-base underlying the role of psychosocial risk factors within LBP care, and a need for uniformity in methodology and terminology across guidelines. PERSPECTIVE: This systematic review summarized clinical guidelines on low back pain (LBP) on how they addressed the identification and management of psychosocial factors. This review revealed a large amount of variety across guidelines in whether and how psychosocial factors were addressed. Moreover, recommendations generally lacked details and were based on low quality evidence.