Abstract
BackgroundThe identification of clinically relevant subgroups of low back pain (LBP) is considered the number one LBP research priority in primary care. One subgroup of LBP patients are those with back related leg pain. Leg pain frequently accompanies LBP and is associated with increased levels of disability and higher health costs than simple low back pain. Distinguishing between different types of low back-related leg pain (LBLP) is important for clinical management and research applications, but there is currently no clear agreement on how to define and identify LBLP due to nerve root involvement.The aim of this systematic review was to identify, describe and appraise papers that classify or subgroup populations with LBLP, and summarise how leg pain due to nerve root involvement is described and diagnosed in the various systems.MethodsThe search strategy involved nine electronic databases including Medline and Embase, reference lists of eligible studies and relevant reviews. Selected papers were appraised independently by two reviewers using a standardised scoring tool.ResultsOf 13,358 initial potential eligible citations, 50 relevant papers were identified that reported on 22 classification systems. Papers were grouped according to purpose and criteria of the classification systems. Five themes emerged: (i) clinical features (ii) pathoanatomy (iii) treatment-based approach (iv) screening tools and prediction rules and (v) pain mechanisms. Three of the twenty two systems focused specifically on LBLP populations.Systems that scored highest following quality appraisal were ones where authors generally included statistical methods to develop their classifications, and supporting work had been published on the systems’ validity, reliability and generalisability. There was lack of consistency in how LBLP due to nerve root involvement was described and diagnosed within the systems.ConclusionNumerous classification systems exist that include patients with leg pain, a minority of them focus specifically on distinguishing between different presentations of leg pain. Further work is needed to identify clinically meaningful subgroups of LBLP patients, ideally based on large primary care cohort populations and using recommended methods for classification system development.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1074-z) contains supplementary material, which is available to authorized users.
Highlights
The identification of clinically relevant subgroups of low back pain (LBP) is considered the number one LBP research priority in primary care
Extensive work has been published on classification systems, where researchers and clinicians have attempted to subgroup LBP patients into homogeneous populations with similar characteristics
50 were selected for inclusion which reported on 22 classification systems
Summary
The identification of clinically relevant subgroups of low back pain (LBP) is considered the number one LBP research priority in primary care. The aim of this systematic review was to identify, describe and appraise papers that classify or subgroup populations with LBLP, and summarise how leg pain due to nerve root involvement is described and diagnosed in the various systems. To tackle the global burden of low back pain (LBP) [1], researchers in primary care have highlighted the identification of clinically relevant subgroups of LBP as the number one research priority [2]. Low back-related leg pain (LBLP) is one of the commonest variations of LBP, with about two thirds of LBP patients presenting with it in primary and secondary care settings [3,4,5]. Leg pain is Stynes et al BMC Musculoskeletal Disorders (2016) 17:226 considered an obstacle to recovery [7, 8], or a marker of severity [4], and the further the pain radiates down the leg, the greater the likelihood of increased levels of disability and health care use, when associated with evidence of positive neurological findings [9]
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