Quality assessment using QUIPS tool.

BackgroundLow back pain (LBP) remains a major global health challenge. Effective management of LBP requires prognostic research to identify people at risk of poor outcome, enabling timely and targeted interventions.ObjectiveTo synthesize the evidence for physical measures of physical functioning as prognostic factors for predicting outcome in LBP.MethodsThis systematic review followed PRISMA and published protocol [PROSPERO-CRD42023406796] [1]. Searches were conducted in MEDLINE, EMBASE, CINAHL, Scopus and ProQuest Dissertations/Theses from inception to 29/5/2024. Hand searches of key journals and screening reference lists of included studies was performed. Prospective longitudinal studies, evaluating physical measures of physical functioning as prognostic factors, in adults 18years≥ with LBP and/or LBP-related leg pain were included. LBP related to malignancy, fracture, infection, cauda equina, inflammatory conditions, and measures; imaging, EMG, and motion capture with force plates or 3D video analysis were excluded. Two independent reviewers screened articles, extracted data, assessed risk of bias (RoB) using QUIPS. Due to high heterogeneity a narrative synthesis was conducted and GRADE determined the quality of evidence.ResultsFrom 15,889 citations, 42 studies were included, with 50% assessed as high RoB. Low-quality evidence supports no predictive ability of high isometric back extension endurance, high handgrip strength, and high fingertip-to-floor test for good long term LBP outcomes. Very low-quality evidence supports inconsistent predictive ability of high lumbar extension range of motion and high straight leg raise range for good short-term outcomes, and high isometric back flexion endurance for good long-term LBP outcome. For studies that could not be synthesized, 41 physical measures of physical functioning were investigated, with 23 of them showing promising predictive ability for LBP outcome.ConclusionThis review highlights a lack of high-quality evidence regarding the predictive ability of physical measures of physical functioning in LBP. Findings indicate that the existing evidence is low-quality for no predictive ability and very low-quality for inconsistent predictive ability of physical measures of physical functioning. Low/very low-quality evidence suggests cautious interpretation. Imprecision, high RoB studies, and inadequately controlled confounding factors contributed to low/very low-quality evidence. This review also identifies emerging potential prognostic factors. An adequately powered, low RoB prospective longitudinal study using standardized measurement protocols and multivariable analysis is required to further investigate the promising predictive ability of physical measures of physical functioning in LBP. Future prognostic research should be grounded in strong theoretical rationale, including biological plausibility.背景：腰痛（Low back pain, LBP）仍是一项重大的全球公共卫生挑战。对腰痛进行有效的管理，需要开展预后研究以识别预后不良风险人群，从而实施及时且具有针对性的干预措施。 目的：系统汇总以躯体功能物理测评指标作为腰痛预后结局预测因素的相关研究证据。 方法：本系统评价遵循《系统评价和荟萃分析优先报告条目》（PRISMA）及已发表的研究方案[PROSPERO-CRD42023406796][1]。检索时限自建库至2024年5月29日，检索数据库包括MEDLINE、EMBASE、护理及相关健康文献累积索引（CINAHL）、斯高帕斯数据库（Scopus）以及ProQuest学位论文全文库（ProQuest Dissertations/Theses）。同时对核心期刊进行手工检索，并筛选纳入研究的参考文献列表。本研究纳入≥18岁腰痛或腰痛相关性腿痛成人受试者、以躯体功能物理测评指标作为预后因素的前瞻性队列研究。排除标准为与恶性肿瘤、骨折、感染、马尾综合征、炎性疾病相关的腰痛，以及影像学检查、肌电图（Electromyography, EMG）、结合测力台或三维视频分析的运动捕捉等测评手段。由2名独立评价者开展文献筛选、数据提取工作，并采用预后研究偏倚风险评估工具（QUIPS）评估偏倚风险（risk of bias, RoB）。鉴于研究间存在较高异质性，本研究采用叙述性综合方法进行证据整合，并采用推荐分级的评估、制定与评价（Grading of Recommendations Assessment, Development and Evaluation, GRADE）标准对证据质量进行评级。 结果：本研究共检索到15889条文献记录，最终纳入42项研究，其中50%的研究被评估为高偏倚风险。低质量证据表明，较高的等长腰背伸耐力、握力以及指地距测试结果，对腰痛长期良好结局无预测价值。极低质量证据显示，较高的腰椎伸活动度与直腿抬高活动度对腰痛短期良好结局的预测能力不一致，较高的等长腰背屈耐力对腰痛长期良好结局的预测能力亦不一致。针对无法进行证据综合的研究，共纳入41项躯体功能物理测评指标，其中23项指标显示出对腰痛结局具有潜在预测价值。 结论：本系统评价显示，目前关于躯体功能物理测评指标对腰痛的预测价值尚无高质量证据支持。研究结果表明，现有证据中，关于躯体功能物理测评指标无预测价值的相关证据为低质量，关于其预测能力不一致的相关证据为极低质量。针对低质量或极低质量证据，解读时需谨慎。证据质量偏低或极低的原因包括结局测量不精确、纳入高偏倚风险研究以及混杂因素控制不足。本研究同时识别出若干新兴的潜在预后因素。未来需开展效力充足、偏倚风险低的前瞻性队列研究，采用标准化测评方案并结合多变量分析，进一步探究躯体功能物理测评指标对腰痛结局的潜在预测价值。未来的腰痛预后研究应基于扎实的理论依据，包括具备生物学合理性。