Screening of the thoracolumbar spine is almost completely absent in trials evaluating conservative management for sacroiliac joint pain: a systematic review of 43 randomized controlled trials

Sacroiliac joint (SIJ) pain is a common diagnosed lumbosacral condition with historical diagnostic uncertainty. Recent literature suggests that effective diagnosis of SIJ pain should begin with screening the thoracolumbar spine, as SIJ regional pain is often linked to referral patterns originating from this area. The aim of this systematic review was to evaluate the screening methods of the thoracolumbar spine in randomized controlled trials (RCT) for the evaluation and treatment of SIJ pain or dysfunction. A search of PubMed, CINAHL, and CENTRAL was conducted for RCTs published from inception up to 31 March 2024. RCTs focusing on SIJ pain as the primary diagnosis, treated with conservative interventions such as manual therapy, exercise, or modalities in adult patients, were included. Data on thoracolumbar spine screening methods were extracted, categorized, and reported with means, standard deviations, and frequency counts. The Revised Cochrane Risk of Bias tool was used to assess each RCT. A total of 2,719 articles were retrieved. After removing duplicates and screening titles, abstracts, and full texts, 43 RCTs were included for data extraction. Two trials (4.7%) performed a reasonable thoracolumbar spine screening process, nine (20.9%) partially completed, and 32 (74.4%) did not perform a thoracolumbar screening process prior to formulating an SIJ diagnosis. Every RCT had at least some of risk of bias. More than 95% of RCT's reported minimal-to-no thoracolumbar screening process prior to developing an SIJ diagnosis, highlighting significant variability and scarcity. The role of screening the thoracolumbar spine prior to diagnosing SIJ pain is notably underrepresented in RCTs providing treatment recommendations for this condition, undermining the strength of the conclusions derived from these studies. This finding highlights the need for further research to establish a standardized clinical thoracolumbar screening process for SIJ pain to ultimately improve patient outcomes for this condition.