European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
Factors influencing referral decisions for patients with chronic low back pain: a scoping review.
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Koopman Floor, van Leeuwen Roos, Soer Remko, Bantel Carsten, Wolff André, Seves Bregje
Аннотация
PURPOSE: Chronic low back pain (CLBP) is a leading cause of disability worldwide, requiring coordinated referrals across different healthcare services. Despite clinical guidelines emphasising a biopsychosocial approach, referral decisions are often unstructured and poorly understood. Existing research has mainly focused on clinical management, with limited attention to the factors influencing referral decisions and their impact on referral pathways. The objective of this scoping review is to map the existing literature on factors influencing referral decisions for patients with non-specific CLBP and identify gaps for future research.
METHODS: Following PRISMA-ScR guidelines and Joanna Briggs Institute guidance for scoping reviews, a comprehensive literature search was conducted across the PubMed, EMBASE, and Web of Science databases. Studies focusing on referral decisions for patients with CLBP were included. Data extraction and descriptive synthesis were performed.
RESULTS: The search yielded 4,816 records, with 13 studies meeting inclusion criteria. Included studies, conducted between 1996 and 2025, spanned Europe, North America, and Israel, and comprised diverse designs including qualitative interviews, surveys, experimental vignettes, cross-sectional and cohort studies. Referral decisions in CLBP care were influenced by an interplay of clinical, psychosocial, patient-related, healthcare professional-related, systemic and contextual factors.
CONCLUSION: This scoping review highlights the multifactorial nature of referral decisions in CLBP care and identifies critical gaps in current research. Future prospective studies are needed to better understand these factors and referral pathways, aiming to improve guideline adherence, patient outcomes, and equity in CLBP management.
METHODS: Following PRISMA-ScR guidelines and Joanna Briggs Institute guidance for scoping reviews, a comprehensive literature search was conducted across the PubMed, EMBASE, and Web of Science databases. Studies focusing on referral decisions for patients with CLBP were included. Data extraction and descriptive synthesis were performed.
RESULTS: The search yielded 4,816 records, with 13 studies meeting inclusion criteria. Included studies, conducted between 1996 and 2025, spanned Europe, North America, and Israel, and comprised diverse designs including qualitative interviews, surveys, experimental vignettes, cross-sectional and cohort studies. Referral decisions in CLBP care were influenced by an interplay of clinical, psychosocial, patient-related, healthcare professional-related, systemic and contextual factors.
CONCLUSION: This scoping review highlights the multifactorial nature of referral decisions in CLBP care and identifies critical gaps in current research. Future prospective studies are needed to better understand these factors and referral pathways, aiming to improve guideline adherence, patient outcomes, and equity in CLBP management.