Which are the most important discriminatory items for subclassifying non-specific low back pain? A Delphi study among...

Developing homogenous low back pain (LBP) classification groups is recommended for enhancing clinical outcomes. However, an important step towards the development of specific subgroups is the selection and consensus agreement among health professionals on the discriminatory clinical items (sings and symptoms) that should be included in the classification process. Thus, this study's objective was to develop a list of clinical features for the assessment of LBP by health care providers within Greece, which are believed to be discriminatory in identifying LBP subgroups.

A random sample stratified by geographical region and work status of 150 Greek physiotherapists (PTs) participated in a two-round Delphi study. PTs were asked to obtain consensus and hierarchy, the most important items out of a list of evaluating/diagnostic features believed to be discriminatory for LBP patients. These items included 80 clinical features and were generated in by PTs and doctors previous work.

Second-round questionnaires were returned by 112 PTs (74.6% response rate). A total of 66 clinical features were rated as important discriminatory items in LBP assessment. Clinical items included characteristics of present symptoms and the history's condition, general medical history, information regarding patient function, patients' attitudes regarding movement, diagnosis, expectations, fear-avoidance beliefs as well as aspects of a physical examination including observation, active and passive movements, neurological and muscular examination.

This is the first study identifying important clinical items for LBP patients in Greece. It may be that these features are 'discriminatory' for different LBP subsets; however, further research is needed.