Reccomendations for the detection, study and referral of inflammatory low-back pain in primary care

Reumatol Clin. 2015 Mar-Apr;11(2):90-8. doi: 10.1016/j.reuma.2014.04.007. Epub 2014 Sep 16.
[Article in English, Spanish]

Abstract

Objective: To design a strategy for the early detection and referral of patients with possible spondyloarthritis based on recommendations developed, agreed upon, and directed to primary care physicians.

Methods: We used a modified RAND/UCLA methodology plus a systematic literature review. The information was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round.

Results: We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years be performed in four phases 1) clinical: key questions, 2) clinical: extra questions, 3) physical examination, and 4) additional tests.

Conclusions: The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments.

Keywords: Atención Primaria; Derivación; Dolor lumbar inflamatorio; Espondiloartritis; Guidelines; Guías; Inflammatory back pain; Primary care; Recomendaciones; Recommendations; Referral; Spondyloarthritis.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Algorithms
  • Chronic Pain / etiology
  • Clinical Decision-Making*
  • Decision Support Techniques*
  • Delphi Technique
  • Early Diagnosis
  • Humans
  • Low Back Pain / etiology*
  • Lumbar Vertebrae*
  • Middle Aged
  • Primary Health Care*
  • Referral and Consultation*
  • Rheumatology
  • Spondylarthritis / complications
  • Spondylarthritis / diagnosis*