Physical measures of physical functioning as prognostic factors to predict outcomes in low back pain: Protocol for a systematic review

PLOS ONE STUDY PROTOCOL Physical measures of physical functioning as prognostic factors to predict outcomes in low back pain: Protocol for a systematic review Rameeza Rashed ID*, Katie Kowalski ID, David Walton, Afieh Niazigharemakhe, Alison Rushton ID School of Physiotherapy, Western University, London, Ontario, Canada * a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Abstract Background OPEN ACCESS Citation: Rashed R, Kowalski K, Walton D, Niazigharemakhe A, Rushton A (2023) Physical measures of physical functioning as prognostic factors to predict outcomes in low back pain: Protocol for a systematic review. PLoS ONE 18(12): e0295761. https://doi.org/10.1371/journal. pone.0295761 Low back pain (LBP) is a highly prevalent condition that substantially impairs individuals’ physical functioning. This highlights the need for effective management strategies to improve patient outcomes. It is, therefore, crucial to have knowledge of physical functioning prognostic factors that can predict outcomes to facilitate the development of targeted treatment plans aiming to achieve better patient outcomes. There is no synthesis of evidence for physical functioning measures as prognostic factors in the LBP population. The objective of this systematic review is to synthesize evidence for physical measures of physical functioning as prognostic factors to predict outcomes in LBP. Editor: Shabnam ShahAli, Iran University of Medical Sciences, ISLAMIC REPUBLIC OF IRAN Received: July 28, 2023 Accepted: November 24, 2023 Published: December 11, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0295761 Copyright: © 2023 Rashed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Data will be published in the paper. Methods The protocol is registered in the International Prospective Register of Systematic Reviews and reported in line with the Preferred Reporting Items for Systematic Review and MetaAnalysis Protocols (PRISMA-P). Prospective longitudinal observational studies investigating potential physical prognostic factors in LBP and/or low back-related leg pain population will be included, with no restriction on outcome. Searches will be performed in MEDLINE, EMBASE, Scopus, CINAHL databases, grey literature search using Open Grey System and ProQuest Dissertations and Theses, hand-searching journals, and reference lists of included studies. Two independent reviewers will evaluate the eligibility of studies, extract data, assess risk of bias and quality of evidence. Risk of bias will be assessed using the Quality in Prognostic Studies (QUIPS) tool. Adequacy of clinical, methodological, and statistical homogeneity among included studies will decide quantitative (meta-analysis) or qualitative analysis (narrative synthesis) focused on prognostic factors and strength of association with outcomes. Quality of cumulative evidence will be evaluated using a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE). PLOS ONE | https://doi.org/10.1371/journal.pone.0295761 December 11, 2023 1 / 11 PLOS ONE Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Physical measures of physical functioning to predict low back pain outcomes Discussion Information about prognostic factors can be used to predict outcomes in LBP. Accurate outcome prediction is essential for identifying high-risk patients that allows targeted allocation of healthcare resources, ultimately reducing the healthcare burden. Registration PROSPERO, CRD42023406796. Introduction Low back pain (LBP) has been a prevalent and persistent global health issue for the past three decades [1]. It continues to rank among the highest causes of Years Lived with Disability, contributing to a decline in functionality throughout the lifespan and imposing a substantial economic burden [1, 2]. Prognostic research enables early identification of people at risk for poor outcomes, facilitating informed decision-making for timely and targeted treatment interventions that aim to improve outcomes and reduce disability burden [3]. A prognostic factor refers to a measurement or characteristic that can predict subsequent health outcomes in the context of a particular health condition, aiding in understanding and anticipating the natural course of the condition [4]. It is, therefore, crucial to have knowledge of prognostic factors that can predict outcomes in LBP for effective management. The Core Outcome Measures in Effectiveness Trials Initiative (COMET) defines physical functioning as the impact of a disease or condition on physical activities of daily living, such as walking, self-care, performance status and disability index [5]. Physical functioning is a multifaceted construct that encompasses various interconnected dimensions. These dimensions include body structure and function, performance of physical activities, social and role functioning [6]. These dimensions interact and influence each other, forming a comprehensive picture of a person’s physical functioning. Limitations in one dimension may impact another, resulting in an increased risk of disability and decreased quality of life [7, 8]. Assessment of physical functioning can be categorized based on recommendations from the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT), evaluating structure or function of a specific body part or system (e.g., muscle endurance, range of motion) [9], evaluating performance on a defined task in a standardized environment (e.g., 6 min walk test) [10], and evaluating activity in an individual’s natural environment (e.g., accelerometery) [9, 10]. Measures of physical functioning offer valuable insight into the broader impact of adverse health conditions on a person’s quality of life, which is a significant concern for the affected individuals [7, 11]. The core outcome set to measure the effectiveness of interventions for LBP also recommends physical functioning as an outcome domain that should be reported in all clinical trials [7]. Physical functioning has been assessed using both patient-reported outcome measures (PROMs) [9] and physical outcome measures [12] such as performance-based outcome measures [13] or clinician-administered outcome measures [14] which offer complementary yet distinct information [15]. PROMs offer insights into patients’ perceived functional well-being [16], their usefulness can b (...truncated)