Abstract / Summary
OBJECTIVE: To determine if a reduced range of motion (ROM) of the spine was a prognostic factor for pain intensity, disability, and global recovery outcomes in patients with specific or nonspecific spinal pain. DESIGN: Prognostic factor systematic review. LITERATURE SEARCH: PubMed, Embase, and CINAHL were searched from inception to February 10, 2026. We also performed forward and backward citation tracking. STUDY SELECTION CRITERIA: Studies of adults with spinal pain where ROM was assessed as a prognostic factor were included. DATA SYNTHESIS: Risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool. The certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Given heterogeneity in the results, a narrative synthesis was conducted. RESULTS: Thirty-seven studies were included: 11 of nonspecific acute low back pain (LBP), 11 of nonspecific chronic or unspecified-duration LBP, four of nonspecific chronic neck pain, two of lumbar spinal stenosis, eight of whiplash-associated disorders (WAD), and one of cervical myelopathy. All studies were rated as high risk of bias. Across conditions and follow-ups, findings were inconsistent. Most studies of acute and chronic LBP reported no clear association between reduced ROM and outcomes. Similar inconsistencies were observed for chronic neck pain, lumbar stenosis, WAD, and cervical myelopathy. When associations were found, they were often unadjusted and based on low-quality analyses. The certainty of the evidence was consistently very low. CONCLUSION: Due to the very low certainty of evidence, it is unclear whether reduced spinal ROM independently predicts pain, disability, and/or global recovery in people with spinal pain. J Orthop Sports Phys Ther 2026;56(10):672-688. Epub 6 Aug 2026. doi:10.2519/jospt.2026.13872.