The RCGP - Clinical and Special Projects, Clinical Guidelines, Acute Low Back Pain. Contents, Index page
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Chapter 2

Evidence Review

Diagnostic Triage

Initial Assessment Methods
(Adapted from AHCPR 1994)


Psychosocial Factors

Risk factors for chronicity


Information to Patients

Initial Assessment Methods (Adapted from AHCPR 1994)

The patient’s age, the duration and description of symptoms, the impact of symptoms on activity and work, and the response to previous therapy are important in the care of back problems. (B)
The initial clinical history can identify ‘red flags’ of possible serious spinal pathology. Such inquiries are especially important in patients over the age of 55. (B)
Symptoms and signs of cauda equina syndrome, widespread neurological involvement and severe or progressive motor weakness are ‘red flags’ for severe neurological risk. (C)
A history of significant trauma relative to age (for example, a fall from a height or motor vehicle accident in a young adult or a minor fall or heavy lift in a potentially osteoporotic or older patient) raises the question of possible fracture. (C)
 Initial assessment should include psychological and socioeconomic problems in the individual’s life since such non-physical factors can complicate both assessment and treatment. (B)
Straight leg raising (SLR) should be assessed and recorded in young adults with sciatica. In older patients with spinal stenosis, SLR may be normal. (B)
Examination for neurological deficits should emphasise ankle and knee reflexes, ankle and great toe dorsiflexion strength, and distribution of sensory complaints. (B)

Waddell 1982, Deyo et al 1992, van den Hoogen et al 1995

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