Self‐reported prognostic factors in adults reporting neck or low back pain: An umbrella review

Gemma Mansell*, Nadia Corp, Gwenllian Wynne‐Jones, Jonathan Hill, Siobhán Stynes, Daniëlle van der Windt

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Background: Numerous systematic reviews have attempted to synthesize evidence on prognostic factors for predicting future outcomes such as pain, disability and return‐to‐work/work absence in neck and low back pain populations. Databases and datatreatment: An umbrella review of systematic reviews was conducted to summarize the magnitude and quality of the evidence for each prognostic factor investigated. Searches were limited to the last 10 years (2008‐11th April 2018, updated 28th September 2020). A two‐stage approach was undertaken: in stage one, data on prognostic factors was extracted from systematic reviews identified from the systematic search that met the inclusion criteria. Where a prognostic factor was investigated in ≥1 systematic review and where 50% or more of those reviews found an association between the prognostic factor and one of the outcomes of interest, it was taken forward to stage two. In stage two, additional information extracted included the strength of association found, consistency of effects and risk of bias. The GRADE approach was used to grade confidence in the evidence. Results: Stage one identified 41 reviews (90 prognostic factors), with 35 reviews (25 prognostic factors) taken forward to stage two. Seven prognostic factors (disability/activity limitation, mental health; pain intensity; pain severity; coping; expectation of outcome/recovery and fear‐avoidance) were judged as having moderate confidence for robust findings. Conclusions: Although there was conflicting evidence for the strength of association with outcome, these factors may be used for identifying vulnerable subgroups or people able to self‐manage. Further research can investigate the impact of using such prognostic information on treatment/referral decisions and patient outcomes.
Original languageEnglish
Pages (from-to)1627-1643
Number of pages17
JournalEuropean Journal of Pain
Issue number8
Early online date2 May 2021
Publication statusPublished - Sept 2021

Bibliographical note

© 2021 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC®

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.


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