Red flags useful to screen for suspect cancer in patients with low back pain: a scoping review protocol

Low back pain (LBP) is defined as pain and discomfort occurring under the costal arch and above the inferior gluteal folds, with or without leg pain. The most common type of low back pain is "non-specific low back pain". It is defined as such because there is no specific pathology that can be the cause. Instead, "specific low back pain" is caused by diseases such as infections, tumors, osteoporosis, ankylosing spondylitis, fractures, inflammatory processes, radicular syndromes, cauda equina syndrome, etc. It is the most common musculoskeletal disorder in the world and the most cause of disability. Most low back pain is benign in nature and specific diagnoses are uncommon; however in some specific cases this clinical presentation of signs and symptoms could hide much more serious conditions. The second most frequent serious pathology, after fracture, that may initially appears as low back pain is tumor pathology (0.2% and 7.0%), condition that turns out to be so dangerous as to be the second leading cause of death in the world according to the WHO. Red flags are signs and symptoms that raise suspicion of the presence of serious diseases; these are clinical aspects of alert that can justify referral to the doctor/specialist and can contraindicate physiotherapy treatment. Clinicians must therefore be able to recognize clinical presentations that are potentially dangerous to the patient that may require further evaluation or emergency referral. Failure to immediately recognize these conditions could lead to incorrect diagnoses resulting in worsening outcomes over time. The tools that will guide the clinician in recognizing the red flags in low back pain are a through medical history and a complete physical examination. Currently we have very little clarity and agreement in the literature about the Red Flags that should be better investigated, a scoping review is strongly required and corresponded to the objectives of this project.